Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/ uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

AIMTo evaluate the protective effects of ginger (Gin) and roselle (Ros) against testicular damage and oxidative stress in a cisplatin (CIS)-induced rodent model. Their protective effects against CIS-induced apoptosis in testicular and epididymal sperms is also investigated.

METHODSEthanol extracts of Gin or Ros (1 g/kg.day) were given orally to male albino rats for 26 days. This period began 21 days before a single CIS intraperitoneal injection (10 mg/kg body weight).

RESULTSGin or Ros given orally significantly restored reproductive function. Both tested extracts notably reduced the CIS-induced reproductive toxicity, as evidenced by restoring the testis normal morphology. In Gin and Ros, the attenuation of CIS-induced damage was associated with less apoptotic cell death both in the testicular tissue and in the sperms. CIS-induced alterations of testicular lipid peroxidation were markedly improved by these plant extracts.

CONCLUSIONThe present results provide further insights into the mechanisms of protection against CIS-induced reproductive toxicity and confirm the essential anti-oxidant potential of both examined extracts.

Animals ; Antineoplastic Agents ; pharmacology ; Antioxidants ; pharmacology ; therapeutic use ; Apoptosis ; drug effects ; Cisplatin ; pharmacology ; Flowers ; Ginger ; Hibiscus ; Magnoliopsida ; Male ; Oxidative Stress ; drug effects ; Phytotherapy ; Plant Extracts ; Plant Roots ; Rats ; Spermatozoa ; drug effects ; Testis ; drug effects ; pathology

AIMTo evaluate the protective effects of Hibiscus sabdariffa (Roselle) and Zingiber officinale (Ginger) against cisplatin-induced reproductive toxicity in rats and to study the mechanisms underlying these effects.

METHODSEthanol extracts of H.sabdariffa or Z.officinale (1g/kg x day) were given p.o. to male albino rats for 26 days, which began 21 days before a single cisplatin i.p. injection (10 mg/kg body weight).

RESULTSExtracts of H.sabdariffa and Z.officinale reduced the extent of cisplatin-induced sperm abnormality and enhanced sperm motility. Both extracts restored the control level of malondialdehyde (MDA) (lipid peroxidation marker) in the cisplatin-treated testis. The cisplatin injection induced decline in the levels of superoxide dismutase (SOD), reduced glutathione (GSH) and catalase (CAT) were significantly reversed to control levels in groups where cisplatin was preceded by the administration of either H.sabdariffa or Z.officinale.

CONCLUSIONBoth H.sabdariffa and Z.officinale treatment increased the activities of testicular antioxidant enzymes and restored sperm motility of cisplatin-treated rats. The protective effects of tested plants are, therefore, suggested to be mediated by their potent antioxidant activities.

Animals ; Antioxidants ; metabolism ; Catalase ; metabolism ; Cisplatin ; toxicity ; Ginger ; Glutathione ; metabolism ; Hibiscus ; Male ; Plant Extracts ; pharmacology ; Rats ; Rats, Wistar ; Seminiferous Tubules ; drug effects ; pathology ; Sperm Motility ; drug effects ; Spermatozoa ; drug effects ; pathology ; Superoxide Dismutase ; metabolism