1. Validation of targeted microsurgical spermatic cord denervation: Comparison of outcomes to traditional complete microsurgical spermatic cord denervation
Asian Journal of Andrology 2019;21(4):319-323
The aim of this study was to validate the effectiveness of targeted microsurgical spermatic cord denervation (MSCD) of the trifecta nerve complex in comparison to traditional full MSCD with complete skeletonization of the spermatic cord in men with chronic orchialgia. Retrospective chart review was performed by a single fellowship-trained microsurgeon between 2011 and 2016. Patients had follow-ups at 6 weeks, 6 months, and 1 year postoperatively. Thirty-nine men with chronic orchialgia underwent full MSCD between 2011 and 2013. In July 2013, after the publication of an anatomic study with identification of Wallerian degeneration of the trifecta nerve complex in men with chronic orchialgia, the technique was changed to targeted MSCD. From July 2013 to March 2016, 43 men underwent targeted MSCD. When comparing the full MSCD group to the targeted MSCD group, there was no significant difference in resolution of pain (66.7% vs 69.8%, P = 0.88), no difference in partial relief of pain (17.9% vs 23.3%, P = 0.55), and no difference in failure to respond rates (15.4% vs 7.0%, P = 0.22) between the two groups. There was no difference in mean change of visual analog pain scale scores between the two groups (P = 0.27). Targeted MSCD had a shorter operative time (53 min vs 21 min, P = 0.0001). Targeted MSCD offers patients comparable outcomes to traditional full MSCD, with a shorter operative time, a less technically challenging surgery, and potentially less risk to cord structures which should be preserved.
2.Validation of targeted microsurgical spermatic cord denervation: comparison of outcomes to traditional complete microsurgical spermatic cord denervation.
Asian Journal of Andrology 2019;21(4):319-323
The aim of this study was to validate the effectiveness of targeted microsurgical spermatic cord denervation (MSCD) of the trifecta nerve complex in comparison to traditional full MSCD with complete skeletonization of the spermatic cord in men with chronic orchialgia. Retrospective chart review was performed by a single fellowship-trained microsurgeon between 2011 and 2016. Patients had follow-ups at 6 weeks, 6 months, and 1 year postoperatively. Thirty-nine men with chronic orchialgia underwent full MSCD between 2011 and 2013. In July 2013, after the publication of an anatomic study with identification of Wallerian degeneration of the trifecta nerve complex in men with chronic orchialgia, the technique was changed to targeted MSCD. From July 2013 to March 2016, 43 men underwent targeted MSCD. When comparing the full MSCD group to the targeted MSCD group, there was no significant difference in resolution of pain (66.7% vs 69.8%, P = 0.88), no difference in partial relief of pain (17.9% vs 23.3%, P = 0.55), and no difference in failure to respond rates (15.4% vs 7.0%, P = 0.22) between the two groups. There was no difference in mean change of visual analog pain scale scores between the two groups (P = 0.27). Targeted MSCD had a shorter operative time (53 min vs 21 min, P = 0.0001). Targeted MSCD offers patients comparable outcomes to traditional full MSCD, with a shorter operative time, a less technically challenging surgery, and potentially less risk to cord structures which should be preserved.
Adult
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Aged
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Denervation/methods*
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Humans
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Male
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Microsurgery/methods*
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Middle Aged
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Pain/surgery*
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Spermatic Cord/innervation*
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Testicular Diseases/surgery*
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Treatment Outcome
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Young Adult
3.Twist and Shout: A Clinical and Experimental Review of Testicular Torsion.
Riyad T ELLATI ; Parviz K KAVOUSSI ; Terry T TURNER ; Jeffrey J LYSIAK
Korean Journal of Urology 2009;50(12):1159-1167
PURPOSE: This review addresses different aspects of testicular torsion from the clinical perspective as well as the basic cellular and molecular events responsible for the post-torsion testicular changes and pathology, including tissue ischemia-reperfusion injury. MATERIALS AND METHODS: A review of all published literature on testicular torsion was performed by use of two search engines. RESULTS: Testicular torsion, or more correctly termed torsion of the spermatic cord, is a surgical emergency in order to salvage the testis. Its incidence is approximately 1 in 4,000 per annum. Testicular torsion must be treated promptly to avoid loss of the ipsilateral testis; however, even with torsion repair and gross testicular salvage, significant injury may still occur. CONCLUSIONS: The cellular and molecular mechanisms leading to ischemia-reperfusion injury are incompletely understood, and adjuncts to surgical treatment have received little attention. Understanding the cellular and molecular effects is important because 25% of males with a history of torsion may experience adult infertility. This review emphasizes current knowledge of basic science results and clinical outcomes of testicular torsion.
Adult
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Apoptosis
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Emergencies
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Humans
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Incidence
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Infertility
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Ischemia
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Male
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Reperfusion
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Reperfusion Injury
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Spermatic Cord
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Spermatic Cord Torsion
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Testis
4.The impact of ipsilateral testicular atrophy on semen quality and sperm DNA fragmentation response to varicocele repair.
Parviz K KAVOUSSI ; Natasha ABDULLAH ; Melissa S GILKEY ; Caitlin HUNN ; G Luke MACHEN ; Shu-Hung CHEN ; Keikhosrow M KAVOUSSI ; Amy ESQUEDA ; J David WININGER ; Shahryar K KAVOUSSI
Asian Journal of Andrology 2021;23(2):146-149
Varicoceles adversely impact semen quality and sperm DNA fragmentation, which typically improve with surgical repair. Some men with varicoceles have ipsilateral testicular atrophy due to damage from the varicocele. This study assessed semen quality and the sperm DNA fragmentation index (DFI) response to varicocele repair in men with ipsilateral testicular atrophy (TA) versus men with no testicular atrophy (NTA). Semen parameter values and DFI in both groups were compared preoperatively and postoperatively. The Mann-Whitney U test and the Wilcoxon signed-rank test were used where appropriate. There were 20 men in the TA group and 121 men in the NTA group with no difference in age, varicocele grade, or preoperative semen parameter values between the two groups. The NTA group had a higher preoperative DFI than the TA group. Both groups showed improvement in semen quality postoperatively, only the TA group showed a significant improvement in DFI, whereas the NTA group showed significant improvements in several parameter values and DFI. The change from preoperative to postoperative parameter values when comparing the two groups revealed a difference in total sperm motile count and DFI, with a larger mean improvement in the NTA group than in the TA group. Both TA and NTA groups showed improved semen quality and DFI after varicocele repair, but the NTA group had more improvement than the TA group. However, only total motile count (TMC) and DFI had a significantly greater mean change in preoperative to postoperative response in the NTA group than in the TA group.
5.Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility
Ashok AGARWAL ; Neel PAREKH ; Manesh Kumar PANNER SELVAM ; Ralf HENKEL ; Rupin SHAH ; Sheryl T HOMA ; Ranjith RAMASAMY ; Edmund KO ; Kelton TREMELLEN ; Sandro ESTEVES ; Ahmad MAJZOUB ; Juan G ALVAREZ ; David K GARDNER ; Channa N JAYASENA ; Jonathan W RAMSAY ; Chak Lam CHO ; Ramadan SALEH ; Denny SAKKAS ; James M HOTALING ; Scott D LUNDY ; Sarah VIJ ; Joel MARMAR ; Jaime GOSALVEZ ; Edmund SABANEGH ; Hyun Jun PARK ; Armand ZINI ; Parviz KAVOUSSI ; Sava MICIC ; Ryan SMITH ; Gian Maria BUSETTO ; Mustafa Emre BAKIRCIOĞLU ; Gerhard HAIDL ; Giancarlo BALERCIA ; Nicolás Garrido PUCHALT ; Moncef BEN-KHALIFA ; Nicholas TADROS ; Jackson KIRKMAN-BROWNE ; Sergey MOSKOVTSEV ; Xuefeng HUANG ; Edson BORGES ; Daniel FRANKEN ; Natan BAR-CHAMA ; Yoshiharu MORIMOTO ; Kazuhisa TOMITA ; Vasan Satya SRINI ; Willem OMBELET ; Elisabetta BALDI ; Monica MURATORI ; Yasushi YUMURA ; Sandro LA VIGNERA ; Raghavender KOSGI ; Marlon P MARTINEZ ; Donald P EVENSON ; Daniel Suslik ZYLBERSZTEJN ; Matheus ROQUE ; Marcello COCUZZA ; Marcelo VIEIRA ; Assaf BEN-MEIR ; Raoul ORVIETO ; Eliahu LEVITAS ; Amir WISER ; Mohamed ARAFA ; Vineet MALHOTRA ; Sijo Joseph PAREKATTIL ; Haitham ELBARDISI ; Luiz CARVALHO ; Rima DADA ; Christophe SIFER ; Pankaj TALWAR ; Ahmet GUDELOGLU ; Ahmed M A MAHMOUD ; Khaled TERRAS ; Chadi YAZBECK ; Bojanic NEBOJSA ; Damayanthi DURAIRAJANAYAGAM ; Ajina MOUNIR ; Linda G KAHN ; Saradha BASKARAN ; Rishma Dhillon PAI ; Donatella PAOLI ; Kristian LEISEGANG ; Mohamed Reza MOEIN ; Sonia MALIK ; Onder YAMAN ; Luna SAMANTA ; Fouad BAYANE ; Sunil K JINDAL ; Muammer KENDIRCI ; Baris ALTAY ; Dragoljub PEROVIC ; Avi HARLEV
The World Journal of Men's Health 2019;37(3):296-312
Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.
Antioxidants
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Classification
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Clinical Protocols
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Diagnosis
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DNA
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Embryonic Structures
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Female
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Fertility
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Health Expenditures
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Humans
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Infertility
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Infertility, Male
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Male
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Membranes
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Ovum
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Oxidants
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Oxidation-Reduction
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Oxidative Stress
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Reactive Oxygen Species
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Reducing Agents
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Reproductive Health
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Semen
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Spermatozoa
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Subject Headings