The Relationship Between Varicoceles and Obesity

Handel, Liann N.; Shetty, Rashmi; Sigman, Mark

doi:10.1016/j.juro.2006.07.023

Cited by 82 publications

(89 citation statements)

References 6 publications

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“…Several molecules, such as insulin, oestrogens, leptin, tumour necrosis factor a (TNFa) or other adipokines, mainly related to increased adiposity, have been hypothesized to induce MetS-related hypogonadism, acting both at a central or at a peripheral level (see for review Corona et al, 2011b). In contrast with the positive association between hypogonadism and MetS, varicocoele was less often found in subjects fulfilling MetS criteria, thus confirming the view that obesity is a protective factor against varicocoele (Handel et al, 2006;Nielsen et al, 2006;Tsao et al, 2009).…”

Section: Discussionmentioning

confidence: 54%

Seminal, ultrasound and psychobiological parameters correlate with metabolic syndrome in male members of infertile couples

et al. 2013

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SUMMARYMetabolic syndrome (MetS) is a diagnostic category which identifies subjects at high risk for diabetes and cardiovascular diseases, erectile dysfunction (ED) and male hypogonadism. However, MetS impact on male infertility has been poorly studied. We systematically evaluated possible associations between MetS and clinical characteristics in men with couple infertility. Out of 367 consecutive subjects, 351 men without genetic abnormalities were studied. MetS was defined according to the International Diabetes Federation&American Heart Association/National Heart,Lung, and Blood Institute classification. All men underwent physical, hormonal, seminal and scrotal ultrasound evaluation. Erectile and ejaculatory functions were assessed by International Index of Erectile Function-15 erectile function domain (IIEF-15-EFD) and Premature Ejaculation Diagnostic Tool (PEDT), respectively, while psychological symptoms by Middlesex Hospital Questionnaire. Out of 351 patients, 27 (7.7%) fulfilled MetS criteria. Among ultrasound features, in an age-adjusted logistic model, only testis inhomogeneity was significantly associated with increasing MetS factors (HR = 1.36 [1.09-1.70]; p < 0.01). In an age-adjusted model, MetS was associated with a stepwise decline in total testosterone (TT) (B = À1.25 ± 0.33; p < 0.0001), without a concomitant rise in gonadotropins. At univariate analysis, progressive motility and normal morphology were negatively related to the number of MetS components (both p < 0.0001), but when age and TT were introduced in a multivariate model, only sperm morphology retained a significant association (B = À1.418 ± 0.42; p = 0.001). The risk of ED (IIEF-15-EFD score <26) increased as a function of the number of MetS factors, even after adjusting for age and TT (HR = 1.45[1.08-1.95]; p < 0.02). No association between PEDT score and MetS was observed. Finally, after adjusting for age and TT, somatization and depressive symptoms were associated with increasing MetS components (B = 0.66 ± 0.03, p < 0.05; B = 0.69 ± 0.03, p < 0.02; respectively). In conclusion, in men with couple infertility, MetS is associated with hypogonadism, poor sperm morphology, testis ultrasound inhomogeneity, ED, somatization and depression. Recognizing MetS could help patients to improve not only fertility but also sexual and overall health.

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Section: Discussionmentioning

confidence: 54%

Seminal, ultrasound and psychobiological parameters correlate with metabolic syndrome in male members of infertile couples

et al. 2013

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“…In 12 studies: first, no significant differences in BMI were detected (Delaney et al, 2004;Kilic et al, 2007), secondly, patients with varicocoele had a distinctly lower BMI (May et al, 2006;Baek et al, 2011), and thirdly, the number of the varicocoele patients decreased as the BMI increased, as found by others (Handel et al, 2006;Nielsen et al, 2006;Prabakaran et al, 2006;Kumanov et al, 2008;Tsao et al, 2009;Al-Ali et al, 2010;Chen & Huang, 2010;Hassanzadeh et al, 2011;Soylemez et al, 2012) and us. It is clear that obesity may lead to decreased detection of varicocoele, even in our study, because of difficulty in palpation on physical examination.…”

Section: Discussionmentioning

confidence: 81%

“…It is clear that obesity may lead to decreased detection of varicocoele, even in our study, because of difficulty in palpation on physical examination. Although the diagnostic difficulty of varicocoele is well known in obese men, the latter finding suggests that the 'nutcracker' phenomenon or other biophysical effects of increased adiposity may play a role in the pathogenesis (Handel et al, 2006;Nielsen et al,2006;Kumanov et al, 2008;Tsao et al, 2009) Nielsen et al (Nielsen et al, 2006) and Handel et al (Handel et al, 2006) have proposed a possible mechanism to explain this concept and stated that fat around the left renal vein may provide a cushion protecting against the nutcracker phenomenon in the obese men. Results of the present study, also support this provocative concept.…”

Section: Discussionmentioning

confidence: 99%

Association of left varicocoele with height, body mass index and sperm counts in infertile men

et al. 2012

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SUMMARYThe aim of this study was to evaluate interrelation of left varicocoele with height, body mass index (BMI) and sperm counts. We retrospectively evaluated the data of all patients who consulted for infertility at a tertiary academic referral centre from 2000 to 2010. Patient's height, weight, BMI, semen analysis, presence or absence of varicocoele and varicocoele side and grade were evaluated. In statistical evaluations chi-square, student's t, Mann-Whitney U, ANOVA and logistic regression analyses were performed. In ANOVA analyses, Bonferroni post hoc test was performed when needed. The data of 1842 among 2780 men, presenting for infertility, were included in the study. There were 587 men (31.9%) with left varicocoele and 1255 (68.1%) men without varicocoele. Two hundred and seventy-two men (14.8%) had grade I or II, and 315 men (17.1%) had grade III varicocoeles. Mean height was 174.3 ± 6.7 and 172.5 ± 7.0 cm in men with and without varicocoele respectively (p < 0.001). The mean BMI of cases without varicocoeles (25.8 kg/m 2 ) was greater than varicocoele group (24.9 kg/m 2 ) (p < 0.001). Percentage of varicocoele was the highest in moderately oligozoospermic males and significantly higher than the men with normal sperm count. As the height increased, the probability of having varicocoele increased, and the inverse is true for BMI. If varicocoeles are a progressive lesion, perhaps taller men with varicocoeles should be followed more closely to evaluate their fertility and androgenic status.

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“…Increased BMI is associated with decreased prevalence of varicoceles. 77,78 However, although correlations with body mass hold for groups of people, they are not necessarily applicable to an individual patient.…”

Section: Clinical Featuresmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

445

586

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N utcracker phenomenon (NCP), also known as left renal vein entrapment,1-3 is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) narrowing (schematic representation of NCP/ nutcracker syndrome [NCS] in Figure 1). Although the terms nutcracker syndrome and nutcracker phenomenon are sometimes used interchangeably in the literature, Shin and Lee 4 emphasize that the nutcracker anatomy is not always associated with clinical symptoms and that some of the anatomic findings suggestive of nutcracker may represent a normal variant or be accounted for by other conditions. Therefore, the term nutcracker syndrome should be reserved for patients with characteristic clinical symptoms associated with demonstrable nutcracker morphologic features. No consensus exists on what symptoms are severe enough to warrant the designation of a clinical syndrome or to what extent various findings may simply reflect different evolutionary stages of the process. Because of these uncertainties, some authors focus on the characteristic anatomic and hemodynamic findings, referring to them as NCP rather than NCS. 5Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Depending on specific manifestations, NCS may be encountered by different medical specialists. Although it may be associated with substantial morbidity, the diagnosis of NCS is often difficult and is commonly delayed. Diagnostic and treatment criteria are not well established, and the natural history of NCS is not well understood. We performed an initial review of the literature through MEDLINE, searching from 1950 to date and using the keywords nutcracker syndrome, nutcracker phenomenon, and renal vein entrapment. We performed additional reviews based on the literature citations of the identified articles. We attempted to elucidate clinical relevance of these conditions and their prominent features and to summarize professional experience. Mayo Clin

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The Relationship Between Varicoceles and Obesity

Cited by 82 publications

References 6 publications

Seminal, ultrasound and psychobiological parameters correlate with metabolic syndrome in male members of infertile couples

Seminal, ultrasound and psychobiological parameters correlate with metabolic syndrome in male members of infertile couples

Association of left varicocoele with height, body mass index and sperm counts in infertile men

Nutcracker Phenomenon and Nutcracker Syndrome

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