Η υπερηχογραφική μελέτη του όγκου και των αιμοδυναμικών παραμέτρων των όρχεων σε ασθενείς με υποκλινική κιρσοκήλη και η συσχέτισή τους με τις παραμέτρους του σπερμοδιαγράμματος

ΕΙΣΑΓΩΓΗ: Αντίθετα με την κλινική μορφή, η υποκλινική κιρσοκήλη δεν αποτελεί ένδειξη θεραπείας ενώ δεν υπάρχουν αξιόπιστοι δείκτες για την αξιολόγηση αυτής ή πρωτόκολλα παρακολούθησης. Στη παρούσα εργασία μας, μελετήσαμε και ακολουθήσαμε έναν πληθυσμό ανδρών με υποκλινική κιρσοκήλη και υπολογίσαμε στατιστικές συσχετίσεις μεταξύ υπερηχογραφικών και κλινικών χαρακτηριστικών. ΥΛΙΚΑ ΚΑΙ ΜΕΘΟΔΟΣ: Η μελέτη μας πραγματοποιήθηκε στην Ουρολογική Κλινική του Γ.Ν. Πατρών το διάστημα 2017-2020. Συμπεριέλαβε 80 άνδρες με υποκλινική κιρσοκήλη. Οι άνδρες χωρίσθηκαν σε Ομάδα 1, ασθενείς με νορμοσπερμία, και Ομάδα 2, ασθενείς με δυσπερμία (τουλάχιστον μία διαταραχή στις βασικές παραμέτρους του σπερμοδιαγράμματος συγκέντρωσης, κινητικότητας και μορφολογίας, κατά WHO). Μετά από 6 μήνες οι ασθενείς επανεξετάσθηκαν κλινικά και επανέλαβαν τον υπερηχογραφικό έλεγχο και το σπερμοδιάγραμμα. ΑΠΟΤΕΛΕΣΜΑΤΑ: Σαράντα τρεις άνδρες αποτέλεσαν την ομάδα 1 και 37 άνδρες την ομάδα 2 (29 άνδρες με ασθενοσπερμία, 8 με ολιγοασθενοσπερμία). Η παρουσία αμφοτερόπλευρης κιρσοκήλης σχετίσθηκε με αυξημένες πιθανότητες δυσπερμίας (RR 2.43, 95% CI 1.45 to 3.89, p=0,006). Στατιστικά σημαντική διαφορά παρατηρήθηκε μεταξύ των ομάδων 1 & 2 ως προς το συνολικό αριθμό προωθητικά κινουμένων σπερματοζωαρίων (TMSC), δείκτη μάζας σώματος, μέγιστη διάμετρο κιρσοειδούς φλέβας αριστερά, μέση τιμή RI (Resistive Index), PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity), FSH και τεστοστερόνη (p<0.05) αλλά όχι ως προς τον συνολικό ορχικό όγκο, τη διαφορά μεταξύ αριστερού και δεξιού όγκου, τη μέγιστη διάμετρο στα δεξιά, την ηλικία και το κλάσμα RI μεταξύ αριστερής και δεξιάς πλευράς (p>0.05). Στην υπο-ομάδα των ανδρών με νορμοσπερμία και ετερόπλευρη κιρσοκήλη (ν=33), η παρουσία μη φθίνουσας παλινδρόμησης κατά τη Valsava συσχετιζόταν με μεγαλύτερη μέγιστη διάμετρο κιρσοειδούς φλέβας (p<0.05). Στην υπο-ομάδα των ανδρών με νορμοσπερμία και αμφοτερόπλευρη κιρσοκήλη (ν=10), οι μέγιστες διάμετροι των αγγείων διέφεραν σημαντικά μεταξύ των διαφορετικών βαθμών παλινδρόμησης (φθίνουσα και μη φθίνουσα κατά τη Valsava) αριστερά και δεξιά, ενώ οι αριστερές κιρσοκήλες ήταν μεγαλύτερες των δεξιών, ανεξαρτήτως τύπου της παλινδρόμησης (p<0.05). Στους άνδρες με νορμοσπερμία δεν διαπιστώθηκαν στατιστικά σημαντικές συσχετίσεις μεταξύ κλινικών και υπερηχογραφικών παραμέτρων. Στην υπο-ομάδα των δυσπερμικών ανδρών με ετερόπλευρη κιρσοκήλη (ν=14), διαπιστώθηκε στατιστικά σημαντική συσχέτιση του συνολικού ορχικού όγκου, της μέσης τιμής RI, του κλάσματος RI και της διαφοράς του ορχικού όγκου με τη συγκέντρωση των σπερματοζωαρίων, καθώς και τη διαφορά ορχικού όγκου και των TMSC και του συνολικού ορχικού όγκου και της τεστοστερόνης (p<0.05). Στην υπο-ομάδα των ανδρών με δυσπερμία και αμφοτερόπλευρη κιρσοκήλη (ν=23), τα μεγέθη των κιρσοκηλών δεν διέφεραν σημαντικά μεταξύ των δύο πλευρών. Διαπιστώθηκε στατιστικά σημαντική συσχέτιση μεταξύ της μέσης τιμής RI και της συγκέντρωσης των σπερματοζωαρίων και της τεστοστερόνης του ορού, και του συνολικού ορχικού όγκου με τη συγκέντρωση των σπερματοζωαρίων, τον TMSC, την κινητικότητα, τη τεστοστερόνη και την FSH (p<0.05). Μετά την πάροδο 6 μηνών, δεν διαπιστώθηκε εξέλιξη σε κλινική κιρσοκήλη. Η ανάλυση κατά ζεύγη ανέδειξε στατιστικά σημαντική μεταβολή στον TMSC στο σύνολο (p<0.05). Οι άνδρες με νορμοσπερμία δεν παρουσίασαν στατιστικά σημαντική μεταβολή (p>0.05). Σε αντίθεση, οι υπο-ομάδες της δυσπερμίας σημείωσαν στατιστικά σημαντικές διαφορές (δυσπερμικοί με ετερόπλευρη κιρσοκήλη, -2.7 +/- 2.33, p=0.002 / δυσπερμικοί με αμφοτερόπλευρη κιρσοκήλη, -0.93 +/- 1.67, p=0.014). Ο δείκτης RI κατά τη διάγνωση παρουσίασε στατιστικά σημαντική, θετική συσχέτιση με τη μεταβολή των TMSC στους άνδρες με δυσπερμία. ΣΥΜΠΕΡΑΣΜΑΤΑ: Η αμφοτερόπλευρη κιρσοκήλη φαίνεται να συνδέεται με αυξημένη πιθανότητα δυσπερμίας έναντι της ετερόπλευρη εντόπισης. Επίσης, η δυσπερμία φαίνεται να συνοδεύεται από επηρεασμένες αιμοδυναμικές παραμέτρους και κυρίως αυξημένη μέση τιμή RI, που ίσως μπορεί να λειτουργήσει σαν δείκτης βαρύτητας. Επίσης, σε άνδρες με δυσπερμία, ο RI σχετίζεται αρνητικά με τη συγκέντρωση και την κινητικότητα των σπερματοζωαρίων. Η πάροδος 6 μηνών ακολουθείται από μείωση του συνολικού αριθμού προοδευτικά κινητών σπερματοζωαρίων στο σύνολο των ανδρών. Η μείωση είναι στατιστικά αλλά και κλινικά σημαντικότερη στους άνδρες που διαπιστώθηκαν με δυσπερμία κατά τον αρχικό έλεγχο. Τέλος, ο δείκτης RI κατά τη διάγνωση παρουσιάζει σημαντική συσχέτιση με τη μεταβολή του TMSC μετά την πάροδο 6 μηνών.INTRODUCTION: Unlike the clinical form, subclinical varicocele is not an indication of treatment, whereas there are no reliable markers for the assessment of the severity or surveillance. In our present study, we evaluated and followed a population of men with subclinical varicocele and calculated statistical correlations between ultrasonographic and clinical characteristics. MATERIALS AND METHODS: Our study was carried out at the Urological Clinic of General Hospital of Patras between 2017-2020. It included 80 men with subclinical varicocele. Men were divided into Group 1, patients with normospermia, and Group 2, patients with dyspermia (at least one disorder in the principal parameters of spermogram as per WHO: concentration, motility, and morphology). After 6 months the patients were clinically reviewed with new spermiogram and had an ultrasound repeated. RESULTS: Forty-three and 37 men formed group 1 and group 2 (29 men with asthenospermia, 8 with oligo-asthenospermia), respectively. The presence of bilateral varicocele was associated with an increased relative risk for dyspermia (RR 2.43, 95% CI 1.45 to 3.89, p=0.006). Statistically significant difference was observed between groups 1 & 2 in terms of the parameters Total motile Sperm Count (TMSC), maximal vein diameters on the left, Body mass index, mean RI (Resistive Index), PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity) (p<0.05) but not in terms of total testicular volume, volume deferential, maximal diameters on the right, age, and RI ratio between left and right (p>0.05). In the sub-group of men with normospermia and unilateral varicocele (n=33), the presence of persisting reflux in Valsava was associated with a larger maximum varicose vein diameter (p<0.05). In the sub-group of men with normospermia and bilateral varicocele (n=10), the maximum diameters of the vessels differed significantly between the different degrees of reflux (declining and not declining during the Valsava) left and right, while the left varicoceles were greater than the right ones, regardless of the type of the reflux (p<0.05). In men with normospermia, no statistically significant correlations were found between clinical and ultrasound parameters. In the sub-group of dyspermic men with unilateral varicocele (n=14), a statistically significant correlation of total testicular volume, mean RI value RI ratio and volume differential with sperm concentration; between the testicular volume difference and TMSC; total testicular volume with testosterone (p<0.05). In the sub-group of men with dyspermia and bilateral varicocele (n=23) venous size was not significantly different between sides. A statistically significant correlation was found between the mean RI value with sperm concentration; the mean RI value and serum testosterone; the total testicular volume with sperm concentration, motility, testosterone, TMSC and FSH (p<0.05). After 6 months, a statistically significant difference in TMSC was found among all participants (p<0.05). Men with normospermia showed no statistically significant changes in the TMSC number (p>0.05). In contrast, the sub-groups of dyspermia had statistically significant differences (dyspermic with unilateral varicocele, -2.7 +/- 2.33, p=0.002 / dyspermic with bilateral varicocele, -0.93 +/- 1.67, p=0.014). The RI index at diagnosis showed a statistically significant, positive correlation with the deterioration of TMSC in men with dyspermia. CONCLUSIONS: Bilateral varicocele seems to be associated with an increased likelihood of dyspermia versus unilateral localization. Also, dyspermia appears to be accompanied by affected hemodynamic parameters and especially an increased mean RI value, which may act as a preliminary severity indicator; in men with dyspermia, RI is negatively associated with sperm concentration and motility. The 6-month period is followed by a significant decrease in the total number of progressively motile spermatozoa in all men with subclinical varicocele. However, the decrease is statistically but also clinically more important in men found with dyspermia during the initial check. Finally, the mean RI index at diagnosis shows a significant positive correlation with the change in TMSC after 6 months

The ultrasonographic study of testicular volume and haemodynamic parameters in patients with subclinical varicocele and their correlation with the parameters of spermiogram

INTRODUCTION: Unlike the clinical form, subclinical varicocele is not an indication of treatment, whereas there are no reliable markers for the assessment of the severity or surveillance. In our present study, we evaluated and followed a population of men with subclinical varicocele and calculated statistical correlations between ultrasonographic and clinical characteristics. MATERIALS AND METHODS: Our study was carried out at the Urological Clinic of General Hospital of Patras between 2017-2020. It included 80 men with subclinical varicocele. Men were divided into Group 1, patients with normospermia, and Group 2, patients with dyspermia (at least one disorder in the principal parameters of spermogram as per WHO: concentration, motility, and morphology). After 6 months the patients were clinically reviewed with new spermiogram and had an ultrasound repeated.RESULTS: Forty-three and 37 men formed group 1 and group 2 (29 men with asthenospermia, 8 with oligo-asthenospermia), respectively. The presence of bilateral varicocele was associated with an increased relative risk for dyspermia (RR 2.43, 95% CI 1.45 to 3.89, p=0.006). Statistically significant difference was observed between groups 1 & 2 in terms of the parameters Total motile Sperm Count (TMSC), maximal vein diameters on the left, Body mass index, mean RI (Resistive Index), PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity) (p0.05).In the sub-group of men with normospermia and unilateral varicocele (n=33), the presence of persisting reflux in Valsava was associated with a larger maximum varicose vein diameter (p0.05). In contrast, the sub-groups of dyspermia had statistically significant differences (dyspermic with unilateral varicocele, -2.7 +/- 2.33, p=0.002 / dyspermic with bilateral varicocele, -0.93 +/- 1.67, p=0.014). The RI index at diagnosis showed a statistically significant, positive correlation with the deterioration of TMSC in men with dyspermia. CONCLUSIONS: Bilateral varicocele seems to be associated with an increased likelihood of dyspermia versus unilateral localization. Also, dyspermia appears to be accompanied by affected hemodynamic parameters and especially an increased mean RI value, which may act as a preliminary severity indicator; in men with dyspermia, RI is negatively associated with sperm concentration and motility. The 6-month period is followed by a significant decrease in the total number of progressively motile spermatozoa in all men with subclinical varicocele. However, the decrease is statistically but also clinically more important in men found with dyspermia during the initial check. Finally, the mean RI index at diagnosis shows a significant positive correlation with the change in TMSC after 6 months.ΕΙΣΑΓΩΓΗ: Αντίθετα με την κλινική μορφή, η υποκλινική κιρσοκήλη δεν αποτελεί ένδειξη θεραπείας ενώ δεν υπάρχουν αξιόπιστοι δείκτες για την αξιολόγηση αυτής ή πρωτόκολλα παρακολούθησης. Στη παρούσα εργασία μας, μελετήσαμε και ακολουθήσαμε έναν πληθυσμό ανδρών με υποκλινική κιρσοκήλη και υπολογίσαμε στατιστικές συσχετίσεις μεταξύ υπερηχογραφικών και κλινικών χαρακτηριστικών.ΥΛΙΚΑ ΚΑΙ ΜΕΘΟΔΟΣ: Η μελέτη μας πραγματοποιήθηκε στην Ουρολογική Κλινική του Γ.Ν. Πατρών το διάστημα 2017-2020. Συμπεριέλαβε 80 άνδρες με υποκλινική κιρσοκήλη. Οι άνδρες χωρίσθηκαν σε Ομάδα 1, ασθενείς με νορμοσπερμία, και Ομάδα 2, ασθενείς με δυσπερμία (τουλάχιστον μία διαταραχή στις βασικές παραμέτρους του σπερμοδιαγράμματος συγκέντρωσης, κινητικότητας και μορφολογίας, κατά WHO). Μετά από 6 μήνες οι ασθενείς επανεξετάσθηκαν κλινικά και επανέλαβαν τον υπερηχογραφικό έλεγχο και το σπερμοδιάγραμμα.ΑΠΟΤΕΛΕΣΜΑΤΑ: Σαράντα τρεις άνδρες αποτέλεσαν την ομάδα 1 και 37 άνδρες την ομάδα 2 (29 άνδρες με ασθενοσπερμία, 8 με ολιγοασθενοσπερμία). Η παρουσία αμφοτερόπλευρης κιρσοκήλης σχετίσθηκε με αυξημένες πιθανότητες δυσπερμίας (RR 2.43, 95% CI 1.45 to 3.89, p=0,006). Στατιστικά σημαντική διαφορά παρατηρήθηκε μεταξύ των ομάδων 1 & 2 ως προς το συνολικό αριθμό προωθητικά κινουμένων σπερματοζωαρίων (TMSC), δείκτη μάζας σώματος, μέγιστη διάμετρο κιρσοειδούς φλέβας αριστερά, μέση τιμή RI (Resistive Index), PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity), FSH και τεστοστερόνη (p0.05).Στην υπο-ομάδα των ανδρών με νορμοσπερμία και ετερόπλευρη κιρσοκήλη (ν=33), η παρουσία μη φθίνουσας παλινδρόμησης κατά τη Valsava συσχετιζόταν με μεγαλύτερη μέγιστη διάμετρο κιρσοειδούς φλέβας (p0.05). Σε αντίθεση, οι υπο-ομάδες της δυσπερμίας σημείωσαν στατιστικά σημαντικές διαφορές (δυσπερμικοί με ετερόπλευρη κιρσοκήλη, -2.7 +/- 2.33, p=0.002 / δυσπερμικοί με αμφοτερόπλευρη κιρσοκήλη, -0.93 +/- 1.67, p=0.014). Ο δείκτης RI κατά τη διάγνωση παρουσίασε στατιστικά σημαντική, θετική συσχέτιση με τη μεταβολή των TMSC στους άνδρες με δυσπερμία.ΣΥΜΠΕΡΑΣΜΑΤΑ: Η αμφοτερόπλευρη κιρσοκήλη φαίνεται να συνδέεται με αυξημένη πιθανότητα δυσπερμίας έναντι της ετερόπλευρη εντόπισης. Επίσης, η δυσπερμία φαίνεται να συνοδεύεται από επηρεασμένες αιμοδυναμικές παραμέτρους και κυρίως αυξημένη μέση τιμή RI, που ίσως μπορεί να λειτουργήσει σαν δείκτης βαρύτητας. Επίσης, σε άνδρες με δυσπερμία, ο RI σχετίζεται αρνητικά με τη συγκέντρωση και την κινητικότητα των σπερματοζωαρίων. Η πάροδος 6 μηνών ακολουθείται από μείωση του συνολικού αριθμού προοδευτικά κινητών σπερματοζωαρίων στο σύνολο των ανδρών. Η μείωση είναι στατιστικά αλλά και κλινικά σημαντικότερη στους άνδρες που διαπιστώθηκαν με δυσπερμία κατά τον αρχικό έλεγχο. Τέλος, ο δείκτης RI κατά τη διάγνωση παρουσιάζει σημαντική συσχέτιση με τη μεταβολή του TMSC μετά την πάροδο 6 μηνών

Atypical small acinar proliferation and its significance in pathological reports in modern urological times

Atypical small acinar proliferation is a histopathological diagnosis of unspecified importance in prostate needle-biopsy reports, suggestive but not definitive for cancer. The terminology corresponds to some uncertainty in the biopsy report, as the finding might represent an underlying non-cancerous pathology mimicking cancer or an under-sampled prostate cancer site. Therefore, traditional practice favors an immediate repeat biopsy. However, in modern urological times, the need of urgent repeat biopsy is being challenged by some authors as in the majority of cases, the grade of cancer found in subsequent biopsy is reported to be low or the disease to be non-significant. On the other hand, high risk disease cannot be excluded, whereas no clinical or pathological factors can predict the final outcome. In this review, we discuss the significance of the diagnosis of atypical small acinar proliferation in the biopsy report, commenting on its importance in modern urological practice. (c) 2022 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/)

The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

Objective: The increasing use of scrotal ultrasonography (US) for non-cancerous indications has led to greater detection of incidental, small testicular masses. Operative intervention is currently the mainstay of treatment for all testicular tumours; however, despite the low malignant potential of small, incidental masses, little is known about conservative management using radiological surveillance. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted and studies meeting the inclusion criteria were reviewed for patient outcomes. Results: A total of 293 patients across six studies underwent radiological surveillance for an incidental small testicular mass. Infertility was the main indication for investigation and all studies used US as the surveillance modality. A total of 37 patients (12.6%) underwent surgical exploration during follow-up, with only 10 (3.4%) found to have malignant disease at histology. Conclusions: Radiological surveillance of incidental small testicular masses is safe when used for select patient groups due to the high probability of benign disease, although optimal patient selection criteria and a well-defined protocol are lacking. This approach could be considered in patients with incidental, impalpable testicular masses of <= 5 mm in diameter displaying no significant size increase or internal vascularity on US and with negative tumour markers, as the probability of malignancy in these patients is low

Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia

Introduction: In comparison to its clinical analogue, the subclinical varicocele represents a questionable entity and specific guidelines for the optimal management are lacking. In our previous study of patients with subclinical varicocele, we showed that bilateral condition is associated with risk of dyspermia. In the present study, we evaluated the risk of deterioration of semen quality in men with bilateral disease and impaired motility according to WHO criteria. Materials and methods: Men with bilateral subclinical varicocele, not desiring fatherhood at the time of presentation, were included in study. During initial evaluation, the number of Total Motile Sperm Count (TMSC) was calculated and the patients' age, total testicular volume (TTV), maximum venous size and mean resistive index (RI) of the intratesticular arteries were recorded. We classified the participants in five classes according to the TMSC reading: class A-: TMSC < 5 x 10(6), class A: TMSC between 5-10 x 10(6), class B: TMSC between 10-15 x 10(6), class C: TMSC between 15-20 x 10(6), and class D: TMSC > 20 x 10(6) per ejaculate. The participants were seen after 6 months for a repeat spermiogram and physical examination. If clinical varicocele was diagnosed or a new abnormality in the spermiogram was noted, the participants were excluded from the study. The remaining patients were allocated to two groups according to the repeat TMSC, reading: patients sub-classified into a lower class (group 1), and patients remaining at the same class (group 2). A comparative analysis was performed between two groups. Results: Nineteen men were included. Nine patients were subclassified (group 1). Three patients moved to A- class (< 5 x 10(6)). Ten patients remained in the same class having no deterioration (group 2). Comparing the two groups, no statistically significant difference was recognized for age, TTV, maximum venous size on both sides, and mean RI (p > 0.05). However, the initial reading for TMSC was 14.57 x 10(6) in group 1, and 22.84 x 10(6) in group 2, respectively. This difference was statistically significant (p < 0.05). Additionally, in a paired analysis there was a significant difference in TMSC after 6 months (p < 0.05), too. Conclusions: Young men with bilateral varicocele and asthenospermia seem to be at risk of deterioration in their semen quality after a follow-up of 6 months. The measurement of TMSC, can unmask patients at risk, whereas men with the lowest readings seem to be at highest risk for deterioration. The possibility of a worsening sperm quality should be considered in she appropriate clinical context

Vitamins as primary or adjunctive treatment in infertile men with varicocele: A systematic review

Objective: To investigate the usage and the efficacy of vitamins as primary or adjuvant treatment in infertile men with varicocele. Methods: A systematic search in PubMed, the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane Library with the terms (varicocele) AND (vitamins) was performed. We searched for studies: a) reporting the administration of vitamins (individually or as part of a complex) in men with varicocele and infertility, b) primarily or adjuvant to invasive treatment, and c) reporting the impact on semen parameters and/or pregnancy rates. Exclusion criteria were animal, adolescent and non-English studies, grey literature and trials reporting abstracts only. Results: Seven studies were identified eligible for qualitative analysis. All studies were randomised except one (case series). Vitamins were administered dominantly as part of antioxidant complex and only two studies used vitamins (C and E, respectively) as sole agent. In two studies, vitamin monotherapy resulted in improvement in semen quality, but the effect on pregnancy rates is unknown. One study reported no efficacy of adjuvant multivitamin treatment after embolisation in terms of both semen quality and pregnancy rates. Finally, four studies reported a positive effect of vitamins on semen parameters after varicocelectomy, but the effect on pregnancy rates is conflicting; one study reported improved pregnancy rates with adjuvant treatment, two studies did not evaluate the pregnancy rates, and in one study the outcome was unclear due to missing data. Conclusions: Vitamins have been used mostly as part of an antioxidant panel for the management of infertile men with varicocele. Most studies have found a positive impact on semen parameters in selected men with varicocele and infertility, as primary or adjuvant treatment. However, the clinical benefit of vitamins administration on pregnancy rate is under-evaluated and should be the target of future research

L-carnitine as primary or adjuvant treatment in infertile patients with varicocele. A systematic review

Background: Varicocele has been found to impair the function of the epididymis resulting in subfertility whereas the varicocelectomy can resolve the phenomenon. L-carnitine is regarded as a biomarker for the function of the epididymis and has been found in reduced concentrations in infertile patients of various causes, including infertile men with varicocele. It seems that L-carnitine and varicocele share clinical significance and the area of research looks promising. Objective: To identify the role of L-carnitine in the treatment of varicocele. Materials and methods: A systematic search was performed in Pubmed/Medline with the terms (L-carnitine) and (varicocele) and (L-carnitine) and (varicocelectomy). Inclusion criteria were studies reported outcomes of L-carnitine administration alone or in duet, as primary or adjuvant treatment to varicocele. Exclusion criteria were non-English language and animal studies. Studies using L-carnitine as part of a panel of therapeutic agents were avoided. Results: Only four suitable studies were identified for discussion. In one randomized study, the combination of L-carnitine and cinnoxicam improved semen parameters in patients with non-high-grade varicocele compared to L-carnitine alone and had a favourable effect on pregnancy rates but the effect of grade is unknown. In another study, as an adjuvant treatment to varicocelectomy, L-carnitine showed no clear benefit. Finally, in comparison to surgery, the results are inconclusive; two studies showed some benefit might be expected in low-grade or subclinical varicocele, but surgery appears superior. Conclusions: The evidence regarding the role of L-carnitine as a primary or adjuvant treatment of varicocele is sparse. The pathophysiological significance of L-carnitine implicates a potential role of the molecule in the management of varicocele, but the evidence so far is controversial for any recommendations. L-carnitine might be taken into consideration in selected cases; however, further search is needed in order the optimal role of L-carnitine in infertile patients with varicocele to be clarified

The usefulness of elastography in the evaluation and management of adult men with varicocele: A systematic review

Objective To review the role of elastography in the evaluation and decision-making of adult, infertile men with varicocele. Methods A systematic search using the terms (Elastography) AND (Varicocele), (Stiffness) AND (Varicocele), (Elastography) AND (Male infertility) was performed in Pubmed/Medline. Studies reporting a) elastographic characteristics in varicocele-bearing comparing to normal testicles, and b) the correlation of elastography with varicocele grading, parameters of spermatogenesis, and outcomes of varicocele treatment were selected. Exclusion criteria were animal, adolescents, abstracts, and non-English language studies. Results In total, 453 articles were identified; 11 eligible studies were selected. Several modalities were used (shear wave elastography, strain elastography, quasistatic ultrasound elastography, acoustic radiation force impulse). Varicocele-bearing testicles have significantly different stiffness and elasticity in comparison to normal and non-varicocele testicles. Although not in full agreement, elastography readings are correlated with semen parameters. Conflicting results were reported regarding grading as most of the studies failed to demonstrate a significant correlation. Shear wave elastography showed a significant correlation with the improvement in semen parameters after varicocelectomy, but the association with pregnancy rates is unknown. Finally, no studies were identified comparing elastography with other modalities. Conclusions Elastography can detect changes in the architecture of varicocele-bearing testicles. Although the role of the modality in grading is uncertain, elastography showed a meaningful correlation with spermatogenesis parameters. Importantly, elastography readings could predict the improvement in semen parameters after varicocelectomy which is useful in terms of decision-making in infertile men with varicocele

COVID-19 and Male Infertility: Is There a Role for Antioxidants?

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), jeopardizes male fertility because of the vulnerability of the male reproductive system, especially the testes. This study evaluates the effects of the virus on testicular function and examines the potential role of antioxidants in mitigating the damage caused by oxidative stress (OS). A comprehensive PubMed search examined exocrine and endocrine testicular function alteration, the interplay between OS and COVID-19-induced defects, and the potential benefit of antioxidants. Although the virus is rarely directly detectable in sperm and testicular tissue, semen quality and hormonal balance are affected in patients, with some changes persisting throughout a spermatogenesis cycle. Testicular pathology in deceased patients shows defects in spermatogenesis, vascular changes, and inflammation. Acute primary hypogonadism is observed mainly in severely infected cases. Elevated OS and sperm DNA fragmentation markers suggest redox imbalance as a possible mechanism behind the fertility changes. COVID-19 vaccines appear to be safe for male fertility, but the efficacy of antioxidants to improve sperm quality after infection remains unproven due to limited research. Given the limited and inconclusive evidence, careful evaluation of men recovering from COVID-19 seeking fertility improvement is strongly recommended

sj-docx-2-tau-10.1177_17562872231215177 – Supplemental material for Risk and benefits of penile length preservation techniques during penile prosthesis implantation: a systematic review by the young academic urologists sexual and reproductive health working group

Supplemental material, sj-docx-2-tau-10.1177_17562872231215177 for Risk and benefits of penile length preservation techniques during penile prosthesis implantation: a systematic review by the young academic urologists sexual and reproductive health working group by Marco Falcone, Mirko Preto, Afonso Ribeiro Morgado, Ioannis Sokolakis, Selçuk Sarıkaya, Marco Capece, Paolo Capogrosso, Celeste Manfredi, Georgios Tsampoukas and Giorgio Russo in Therapeutic Advances in Urology</p