Varicocele Related Testicular Atrophy and its Predictive Effect Upon Fertility

Pinto, Kirk J.; Kroovand, R. Lawrence; Jarow, Jonathan P.

doi:10.1016/s0022-5347(17)32710-6

Cited by 101 publications

(57 citation statements)

References 27 publications

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“…[2][3][4] While varicoceles are the most easily treatable cause of male infertility, these vascular malformations are associated with a progressive worsening of testicular function if left untreated. [5][6][7] Varicocele repair improves semen quality and sperm DNA integrity, 8 increases clinical pregnancy and live birth rates during in-vitro fertilization (IVF) via intra-cytoplasmic sperm injection (ICSI) 9 and potentially recovers semen parameters in men with nonobstructive azoospermia. 10,11 While the effects of varicocele repair are well-established, the method of correction that is most cost-effective, is controversial.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Kovac

Fantus

Lipshultz

et al. 2014

CUAJ

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Introduction: Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility. Methods: A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes. Results: Primary treatment with MV was the most cost-effective strategy at $5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about $7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >$4100 CAD/pregnancy. Conclusions: MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Kovac

Fantus

Lipshultz

et al. 2014

CUAJ

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“…The prevalence of testicular hypotrophy/atrophy is dependent on the underlying cause of the condition. [20][21][22] In our cohort of men attending a prostate cancer screening program, the prevalences of unilateral and bilateral testicular hypotrophy/atrophy were, respectively, 9.7% and 5.4%.…”

Section: Testicular Hypotrophy/atrophymentioning

confidence: 83%

Prevalence and risk factors for scrotal lesions/anomalies in a cohort of Brazilian men ? 40 years of age

Romero

Romero²,

Almeida

et al. 2014

Sao Paulo Med. J.

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OBJECTIVE: To estimate the prevalence of and risk factors for cutaneous lesions of the scrotum and intrascrotal lesions/anomalies among men included in a prostatic cancer screening program in a Brazilian metropolitan city. DESIGN AND SETTING: Cross-sectional study, private outpatient healthcare service. METHODS: 1731 men aged 40 years or over, participating in a prostate cancer screening program conducted by the municipal public employees' healthcare system, underwent systematic urological assessment by a single examiner. RESULTS:The prevalence of scrotal diseases in our sample was 44.7% (773/1731). Tinea cruris occurred in 203 (11.7%) of the participants, with higher risk among diabetics and lower prevalence among nonwhite individuals; scrotal tinea in eight (0.5%), with higher risk among hypertensive men; subcutaneous nodules in 12 (0.7%), especially in individuals with low schooling level; hydrocele in 283 (16.4%), with higher frequency among participants over the age of 60 years, diabetics or individuals with previous histories of nonspecific urethritis; spermatoceles in 174 (10.1%), with greater prevalence among individuals over the age of 60 years or diabetics, and lower frequency among individuals who underwent vasectomy; unilateral testicular hypotrophy/atrophy in 167 (9.7%) and bilateral hypotrophy/atrophy in 93 (5.4%), both occurring more frequently in individuals over the age of 60 years; absence of palpable testicles due to cryptorchidism in 7 (0.4%); and epididymitis/orchitis in 5 (0.3%), with higher prevalence among diabetics. No cases of cancer were identified in this sample. CONCLUSIONS: Scrotal diseases were highly prevalent in this population of Brazilian men.RESUMO OBJETIVO: Estimar a prevalência e fatores de risco de lesões cutâneas do escroto e de lesões/anomalias intraescrotais entre participantes de programa de rastreamento para câncer de próstata em uma cidade metropolitana brasileira. TIPO DE ESTUDO E LOCAL: Estudo transversal, serviço privado de atendimento ambulatorial à saúde. MÉTODOS: 1.731 homens com idade igual ou superior a 40 anos, participantes do programa de rastreamento de câncer de próstata conduzido pelo sistema de saúde dos funcionários públicos municipais, foram submetidos à avaliação urológica sistemática por um único examinador. RESULTADOS: A prevalência de doenças escrotais nossa amostra foi de 44.7% (773/1731). Tinea cruris ocorreu em 203 (11,7%) dos participantes, com maior risco em diabéticos e menor prevalência em indivíduos não brancos; tinea escrotal em oito (0,5%), com maior risco em homens hipertensos; nódulos subcutâneos em 12 (0,7%), especialmente em indivíduos com baixa escolaridade; hidrocele em 283 (16,4%), com maior frequência nos participantes com mais de 60 anos, diabetes ou história prévia de uretrite inespecífica; espermatoceles em 174 (10,1%), com maior prevalência acima dos 60 anos de idade ou com diabetes, e menor frequência naqueles submetidos a vasectomia; hipotrofia/atrofia testicular unilateral em 167 (9,7%) e hipotrofia/atrofia bilatera...

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“…The underlying mechanisms causing the harmful influence of varicocele on testis still require further explanation; nevertheless it has been reported that operative treatment of varicocele provides a beneficial effect on the male gonad [10,11]. it is beyond a doubt that males with varicocele, the number and agility of the sperm cells are impaired and the morphological structure of the sperm cells is changed.…”

Section: Discussionmentioning

confidence: 99%

Distant 10 years results of laparoscopic operative treatment in patients with varicocele

et al. 2009

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AbstractVaricocele has been regarded a curable cause of infertility for dozens of years. The impact of varicocele treatment in terms of increase in pregnancy rates is a debated issue. We evaluate data from a 10-year cohort of results from laparoscopic operative treatment of varicocele patients according to pregnancy rate, complication rate, and satisfaction with varicocele repair. Ninety seven patients were treated by means of laparoscopy between 1993 and 1996. Ten years after operation questionnaires were sent to all patients. Answers were obtained from 49/97 pts. (50,5%). Details connected with marital status, pregnancy rate, addictions and scrotal pain discomfort were collected. Statistical analysis was performed using chi-square independence test and Spearman’s rank correlation coefficient. After 10 years, 75.5% who answered the questionnaire were fully satisfied with the results of treatment, 12.3% pts of patients were partially satisfied; 63.3% of patients fathered 1 to 3 children. Married patients and those who fathered children were found to be the most satisfied with the operation. We also found the statistically significant negative dependency between smoking addiction and number of children. There were no major complications intra- or postoperatively. No harmful consequences of testicular artery ligation were found. In conclusion, long-time 10 years follow-up enables better estimation of the results of laparoscopic treatment in patients with varicocele. Pregnancy rate may depend not only on varicocele repair but on smoking addiction as well. There is still no evidence of harmful consequences due to testicular artery ligation after varicocele repair

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Varicocele Related Testicular Atrophy and its Predictive Effect Upon Fertility

Cited by 101 publications

References 27 publications

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Prevalence and risk factors for scrotal lesions/anomalies in a cohort of Brazilian men ? 40 years of age

Distant 10 years results of laparoscopic operative treatment in patients with varicocele

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