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Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve.

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Idiopathic varicocele is closely associated with male infertility or subfertility. Sertoli cell is a very important regulator of spermatogenesis. We investigated the morphofunctional alterations in the Sertoli cell and its possible involvement in the establishment of testicular primary lesion in experimental left-sided varicocele, induced from peripuberty. Twenty-five male peripubertal rats (44 days postpartum [dpp]) were distributed into two groups: control (C) and varicocele (V). Experimental left varicocele was induced in rats through the partial ligature of the left renal vein. Euthanasia was performed at 100 dpp. Testicular histopathology and testosterone plasmatic level were evaluated. Transferrin and vimentin proteins were, respectively, used as immunomarkers of Sertoli cell function and structure. Significant reductions in vimentin and transferrin expressions were noticed in androgen-dependent stages (VII and VIII) of the seminiferous epithelium cycle in V rats; testosterone plasmatic level was also reduced. Bilateral testicular histopathological alterations were found in V rats, mainly massive germ cell desquamation. The histological damage and changes in protein expressions occurred bilaterally. The relevant impairment of the functional and structural characteristics of the Sertoli cell, together with the typical massive germ cell desquamation, indicates that Sertoli cell changes can primarily contribute to the significant testicular dysfunction associated with varicocele.

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RESUMEN Introducción: Se estudian los factores que afectan el ADN espermático en la actualidad y en qué medida influyen en la aplicación de las técnicas de reproducción asistida de alta tecnología. La fertilización in vitro es un tema de interés que ha motivado a muchos investigadores. Objetivo: Determinar la relación que existe entre el índice de fragmentación del ADN de la cromatina espermática y los resultados de la técnica de fertilización in vitro en parejas infértiles. Métodos: Se realizó un estudio descriptivo transversal en 107 parejas infértiles remitidas del Programa Nacional de Atención a la pareja infértil, donde se precisó la asociación entre el potencial fertilizante y las variables de resultados: tasa de fertilización, calidad embrionaria y embarazo. Se estudiaron, además, algunos factores que pueden influir en el grado de fragmentación del ADN. Resultados: El potencial fertilizante no se relacionó con la tasa de fertilización, ni con el embarazo clínico, pero sí con la calidad embrionaria (P= 0.036). La edad paterna resultó ser estadísticamente significativa en relación con el potencial fertilizante (P= 0.032). La presencia de varicocele se asoció con el bajo potencial fertilizante (OR= 5,27; IC 95 por ciento [1.34 - 24.09]). Conclusiones: El índice de fragmentación del ADN de la cromatina espermática afecta negativamente la calidad de los embriones a transferir. La edad y el varicocele se relacionan positivamente con el grado de fragmentación del ADN espermático. El consumo de alcohol, el hábito de fumar y la exposición a agentes físicos y químicos no se relacionaron con el índice de fragmentación del ADN espermático en este estudio(AU)

ABSTRACT Introduction: The factors that affect the spermatic DNA are being studied at present and in what extent they affect the implementation of high technology assisted reproduction techniques. In vitro fertilization is a topic of interest that has motivated many researchers. Objective: To determine the relationship between the rate of DNA fragmentation of sperm chromatin and the results of in vitro fertilization technique in infertile couples. Methods: A descriptive cross-sectional study was conducted in 107 infertile couples referred to the National Program of Attention to the Infertile Couple, where it was specified the association between the potential fertilizer and outcome variables: rate of fertilization, embryo quality and pregnancy. In addition, there were studied some factors that may influence the degree of DNA fragmentation. Results: The fertilizing potential was not related to the rate of fertilization, or with the clinical pregnancy, but it did with the embryo quality (p= 0.036). The paternal age proved to be statistically significant in relation to the fertilizing potential (p= 0.032). The presence of varicocele was associated with the low fertilizing potential (OR = 5.27; CI 95 percent [1.34 - 24.09]). Conclusions: The rate of DNA fragmentation of sperm chromatin negatively affects the quality of the embryos to be transferred. The age and varicocele are positively related with the degree of sperm DNA fragmentation. The consumption of alcohol, the smoking habit and the exposure to chemical and physical agents were not associated with the rate of sperm DNA fragmentation in this study(AU)

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Complete duplication of testicular veins is a rare phenomenon. However, a few cases of duplication of gonadal veins have been reported. Here, I report a case of unusual formation and termination of the right testicular vein in an adult male cadaver. Five veins arose from the pampinniform plexus and entered the abdomen through the deep inguinal ring. The most medial among the five was large (3 mm in diameter) and it continued as a testicular vein and opened into the right edge of the inferior vena cava, 1 cm above the union of the common iliac veins. The other four veins were about 1 mm in diameter and they united to form two veins in front of the lower part of the right psoas and iliacus muscles (about 2 cm above the deep inguinal ring) and the two veins united to form upper testicular vein, 4 cm above the deep inguinal ring. This testicular vein was 3 mm in diameter and it opened into the inferior vena cava, 4 cm above the union of common iliac veins. Having five veins at deep inguinal ring might increase the chances of varicocele and decrease the chances of indirect inguinal hernia.

La duplicación completa de las venas testiculares es un fenómeno raro. Sin embargo, se han reportado algunos casos de duplicación de venas gonadales. En el presente trabajo se informa un caso de formación y terminación inusual de la vena testicular derecha en un cadáver de un hombre adulto. Cinco venas surgieron del plexo pampiniforme y penetraron en el abdomen a través del anillo inguinal profundo. El más medial entre los cinco fue de gran tamaño (3 mm de diámetro) y continuó como una vena testicular y se abrió hacia el margen derecho de la vena cava inferior, 1 cm por encima de la unión de las venas ilíacas comunes. Las cuatro venas restantes eran de 1 mm de diámetro aproximadamente, y se unieron para formar dos venas frente a la parte inferior de los músculos psoas e ilíaco derechos (aproximadamente 2 cm por encima del anillo inguinal profundo). Se unieron dos venas para formar la vena testicular superior, la cual medía 3 mm de diámetro y se abría hacia la vena cava inferior, 4 cm por encima de la unión de las venas ilíacas comunes. Cinco venas en el anillo inguinal profundo podrían aumentar las posibilidades de varicocele y disminuir las posibilidades de una hernia inguinal indirecta.

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AIM: Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes related to male infertility. This study aimed to investigate the correlation between varicocele and somatometric parameters. We also aimed to determine prevalence and treatment ratio of this disorder among healthy young Turkish men. MATERIALS AND METHODS: A total of 2061 young men aged from 19 to 34 years was enrolled and cross sectionally evaluated for status of varicocele. Body mass index was calculated. Patients were categorized as normal weight, overweight and obese using by National Institutes of Health criteria. Patients underwent physical examinations for the presence and grade of varicocele. If the varicocele was found and previously submitted to different treatment modalities, the age of treatment and outcomes were recorded. RESULTS: Varicocele was present in 498 men (24.2%). The mean age of the participants was 22.7 ± 1.8 years, and the median BMI was 22.8 ± 2.0 kg/m². There were no significant differences in age, height, weight and BMI among the patients with different grades of varicocele (p > 0.05). Although no significant difference was found in varicocele prevalence between normal weight and over-weight participants (p > 0.05), obese participants had significantly lower varicocele prevalence compared with normal or over weight participants (p = 0.006). A total of 49 men had scrotal pain and the treatment ratio was only 2.8%. CONCLUSION: Prevalence of varicocele was found in about 24% of healthy young Turkish population. Participants with varicocele had significantly lower BMI values compared with those without varicocele. Our findings supported the hypothesis that individuals with a greater BMI may have advantages in relieving the varicocele, but further studies are required to clarify this issue. Additionally treatment ratio was low among young men with varicocele.

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AIM: Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes related to male infertility. This study aimed to investigate the correlation between varicocele and somatometric parameters. We also aimed to determine prevalence and treatment ratio of this disorder among healthy young Turkish men. MATERIALS AND METHODS: A total of 2061 young men aged from 19 to 34 years was enrolled and cross sectionally evaluated for status of varicocele. Body mass index was calculated. Patients were categorized as normal weight, overweight and obese using by National Institutes of Health criteria. Patients underwent physical examinations for the presence and grade of varicocele. If the varicocele was found and previously submitted to different treatment modalities, the age of treatment and outcomes were recorded. RESULTS: Varicocele was present in 498 men (24.2%). The mean age of the participants was 22.7 ± 1.8 years, and the median BMI was 22.8 ± 2.0 kg/m². There were no significant differences in age, height, weight and BMI among the patients with different grades of varicocele (p > 0.05). Although no significant difference was found in varicocele prevalence between normal weight and over-weight participants (p > 0.05), obese participants had significantly lower varicocele prevalence compared with normal or over weight participants (p = 0.006). A total of 49 men had scrotal pain and the treatment ratio was only 2.8%. CONCLUSION: Prevalence of varicocele was found in about 24% of healthy young Turkish population. Participants with varicocele had significantly lower BMI values compared with those without varicocele. Our findings supported the hypothesis that individuals with a greater BMI may have advantages in relieving the varicocele, but further studies are required to clarify this issue. Additionally treatment ratio was low among young men with varicocele.

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La dilatación de las venas del plexo pampiniforme es un problema médico que ya fue identificado hacia fines del siglo XIX. A pesar de esto, sus consecuencias en el tamaño testicular, parámetros seminales y el impacto en la fertilidad siguen siendo temas debatidos en forma activa en la literatura actual, apoyado principalmente en el desarrollo de nuevas técnicas de laboratorio, exámenes diagnósticos y procedimientos quirúrgicos mínimamente invasivos. Como resultado de esto, hay una serie de interrogantes acerca del varicocele adolescente que no han sido respondidas, principalmente en lo que respecta a la utilidad de realizar una corrección quirúrgica precoz para prevenir una eventual infertilidad futura.

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INTRODUCTION: This case-control study aimed at evaluating testicular volume, pubertal and genital development, and incidence of varicoceles in adolescents and young adults after surgery for hepatosplenic schistosomiasis associated with bleeding oesophageal varices. PATIENTS AND METHODS: The study involved 26 young males with schistosomiasis who were submitted to splenectomy, left gastric vein ligature, and auto-implantation of splenic tissue in the major omentum during childhood. The mean follow-up period was 4 years after surgery. The control group included 15 healthy volunteers from a school in the same region where the cases lived. They were randomly selected, matched by age and epidemiological characteristics, and had schistosomiasis ruled out. All participants underwent thorough clinical and ultrasound examinations. Special attention was paid to sexual characteristics, testicular ultrasonography, and Doppler flowmetry of spermatic veins. RESULTS AND CONCLUSIONS: The patients with schistosomiasis had significant deficits in pubertal and genital development and in testicular volume, especially the left one, and a high incidence of varicoceles (61.5%) without a straight association with testicular atrophy.

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OBJECTIVES: To report a rare case of left renal cell carcinoma causing simultaneous acute left varicocele. We also performed a bibliographic review. METHODS: We present the case of a male adult who was diagnosed as having a left varicocele during a medical exam at his work center and referred to the urology clinic. On physical examination a left flank and hypochondrium mass was found. We analyze the diagnostic tests performed and possible therapies. RESULTS: With the diagnosis of left hypernephroma the patient underwent surgery. A big lower pole and medial portion kidney tumor displacing neighbor structures was found, and left radical nephrectomy was performed. CONCLUSIONS: Although it was easy to diagnose a hypernephroma with the diagnostic tests performed, the clinical presentation is not frequent, neither is the sudden onset of left varicocele. Currently, after 8 years of follow-up, the patient has normal blood-ultrasound tests.

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Com o objetivo de avaliar o volume testicular e a prevalência de varicolece em jovens portadores de esquistossomose na forma hepatoesplênica associada a varizes sangrentas de esôfago foram selecionados, randomicamente, 24 desses pacientes e avaliados clinicamente e por dopplerfluxometria. Esses pacientes foram submetidos, quando crianças, a esplenectomia, ligadura da veia gástica esquerda e auto-implante de tecido esplênico no omento maior a apresentaram um seguimento médio pós-tratamento, de quatro anos, os achados evidenciaram significativo déficit do desenvolvimento da genitália, alta prevalência de varicocele (66,7por cento)e redução do colume testicular, particularmente do testículo esquerdo

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Análisis retrospectivo de 467 expedientes clínicos de pacientes radiadas por padecer cáncer ginecológico. Como resultados se señalan la mayor incidencia de complicaciones en mujeres operadas como parte de su tratamiento, sin establecer en la mayoría de los casos una correlación entre las características del tratamiento aplicado y la aparición de complicaciones.

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É feita uma revisäo atualizada da etiopatogenia e fisiopatologia da varicocele. Com base nestes conhecimento, säo discutidos os critérios para a indicaçäo do tratamento da varicocele, que pode ser conservador ou curúrgico, cujas técnicas cirúrgicas säo comenradas. As indicaçöes säo apresntadas na forma de algoritmo, através das quais säo especificadas as correlaçöes clínicas e laboratoriais. Como conclusäo da experiência de um serviço, apresenta-se a proposta para avalaçäo de adolescentes portadores de varicocele, elaborada por uma equipe multiprofissional e por alguns especialistas, na qual é salientada, inclusive, a importância da abordagem dos aspectos psicossociais

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El varicocele, cuadro clínico frecuentemente visto, es la causa corregible más común de infertilidad;sin embargo, a pesar de múltiples estudios aún existen muchas preguntas sin respuesta y mucho de hipóteticoen los conceptos respecto a la entidad. En el presemte artículo se revisan los diferentes criterios existentes sobre el varicocele: las posibles hipótesis etiológicas, la clínica, las ayudas diagnósticas, el tratamiento principalmente quirúrgico, y por último, se plantean las posibles teorías que causan su estrecha relación con la infertilidad. Se pretende que al aumentar el conocimiento sobre el varicocele se le otorgue mayor importancia y se logre prevenir sus complicaciones y secuelas, principalmente la infertilidad

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Se mencionan los factores que aparecen en la literatura médica, en la etiología del varicocele idiopático o espontáneo. Se señala su mayor frecuencia en el lado izquierda (90,5%). Se describe un nuevo factor anatómico no mencionado nunca antes en la literatura, que consiste en la compresión de la vena renal izquierda, que ya ha recibido la vena testicular izquierda, en la "pinza" arterial aorticomesentérica comprendida entre la cara anterior de la aorta y la cara posterior de la arteria mesentérica superior. Se explica el mecanismo de acción de este factor así como las bases anatómicas en que se fundamenta

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Ao dissecarem, em 18 cadáveres, a parece abdominal posterior, as fáscias renais, as regiöes para e perirrenais e os pedículos renais, os autores descrevem os tipos de tributárias e anastomoses das veias testiculares e cometam esses achados com a etiopatogenia da varicocele. Os autores concluem que o excesso, a escassez ou a ausência de tributárias e anastomoses pode ser benéfico ou maléfico, onde o fundamento é o equilíbrio hemodinâmico intra e perirrenal

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