Objective: To investigate the success rate and safety of percutaneous vasoseminal vesiculography with the disposable vasographic interventional therapy kit (VITK). METHODS: This study included ninety-six 19－65 (mean 43) years old male patients with infertility, hematospermia, seminal vesicle cyst, ejaculatory duct cyst, ejaculatory dysfunction, or vas deferens injury, with disease courses varying from 1 month to 7 years. With an open, multi-centered, single-group, self-controlled design and using the disposable VITK, we treated the patients by percutaneous vasoseminal vesiculography via injection of contrast medium into the vas deferens cavity under local anesthesia. RESULTS: Percutaneous vasoseminal vesiculography was successfully performed in 92 (97.87%) of the patients, which revealed abnormal seminal ducts in 51 cases (54.3%). Among the 28 infertile patients, 3 were found with bilateral and 5 with unilateral vas deferens obstruction. Vesiculitis was detected in 36 (81.8%) of the 44 hematospermia patients and bilateral vas deferens abnormality in 5 (38.5%) of the 13 patients with ejaculatory dysfunction. Transectional damage was observed in 2 patients with vas deferens injury induced by bilateral inguinal hernia repair. Three cases of seminal vesicle cyst and 4 cases of ejaculatory cyst were definitely diagnosed by vasoseminal vesiculography. CONCLUSIONS The disposable vasographic interventional therapy kit, with the advantages of simple operation and high safety, deserves a wide clinical application in vasoseminal vesiculography.
Adult ; Aged ; Contrast Media ; administration & dosage ; Cysts ; diagnostic imaging ; Ejaculatory Ducts ; diagnostic imaging ; Genital Diseases, Male ; diagnostic imaging ; Hemospermia ; diagnostic imaging ; etiology ; Hernia, Inguinal ; surgery ; Humans ; Infertility, Male ; diagnostic imaging ; Injections ; Male ; Middle Aged ; Postoperative Complications ; diagnostic imaging ; etiology ; Radiography ; methods ; Seminal Vesicles ; diagnostic imaging ; Vas Deferens ; diagnostic imaging ; injuries ; Young Adult

This study was performed to investigate a potential marker for the presence of spermatozoa in the ejaculate following varicocelectomy in Chinese men with nonobstructive azoospermia and varicoceles. The micro-RNA (miR)-192a levels in seminal plasma and testicular tissue were evaluated by quantitative real-time polymerase chain reaction from 60 men with nonobstructive azoospermia and varicoceles (Group A: 27 men with spermatozoa found in the ejaculate after surgery; Group B: 33 men without spermatozoa found in the ejaculate after surgery) and 30 controls. The seminal plasma and testicular tissue miR-192a levels were higher in Group B than in Group A and the controls (P < 0.001), and there was no significant difference between Group A and the controls (P > 0.05). Apoptosis and proliferation assays with miR mimics and inhibitors showed that miR-192a induced GC-2 cell apoptosis through the activation of Caspase-3 protein. Thus, seminal plasma miR-192a appears to be a potential marker for successfully indicating spermatozoa in the ejaculate following microsurgical varicocelectomy in men with nonobstructive azoospermia and varicoceles. Seminal plasma miR-192a may be a useful clinical marker for prescreening to determine which patients with nonobstructive azoospermia and varicoceles would benefit from varicocelectomy.
Adult ; Apoptosis ; Asian People ; Azoospermia/surgery* ; Biomarkers/analysis* ; Caspase 3/analysis* ; Cell Proliferation ; Humans ; Infertility, Male/etiology* ; Male ; MicroRNAs/biosynthesis* ; Microsurgery ; Predictive Value of Tests ; Semen/metabolism* ; Testis/metabolism* ; Treatment Outcome ; Varicocele/surgery*

Ejaculatory duct obstruction (EDO) is one of the obstructive factors for 1－5% of all cases of male infertility and it is, however, surgically correctable. Congenital developmental abnormality is a most common cause of EDO. The clinical manifestations of EDO are varied, typically with the decline of four semen parameters. Transrectal ultrasonography is an important imaging method for the diagnosis of EDO and guidance in its surgery. MRI provides high-resolution images of the reproductive system as evidence. Transurethral resection of the ejaculatory duct (TURED) is a classical operation, the application of transurethral seminal vesiculoscopy has become a new trend of minimally invasive surgery in the treatment of EDO, and the latest flexible vesiculovasoscopy (FVV) or vasoscopy techniques may further improve the diagnosis and treatment of EDO.
Adult ; Ejaculatory Ducts ; diagnostic imaging ; surgery ; Genital Diseases, Male ; diagnostic imaging ; surgery ; Humans ; Infertility, Male ; etiology ; Magnetic Resonance Imaging ; Male ; Semen ; Ultrasonography ; Vas Deferens ; diagnostic imaging

OBJECTIVETo investigate the clinical effect of microsurgical vasoepididymostomy and/or vasovasostomy in the treatment of obstructive azoospermia.

METHODSThis study included 76 patients with obstructive azoospermia, 53 treated by bilateral vasoepididymostomy (8 involving the epididymal head, 18 involving the epididymal body, 5 involving the epididymal tail, and 22 involving the epididymal head, body and tail), 14 by unilateral vasoepididymostomy, and the other 9 by unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis). We followed up the patients for 2 to 16 months for the patency rate, routine semen parameters, and pregnancy outcomes.

RESULTSThe success rate of bilateral vasoepididymostomy, unilateral vasoepididymostomy, and unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis) were 62.26% (33/53), 35.71% (5/14), and 77.78% (7/9), respectively. The average sperm concentrations in the three groups of patients were (27.9 +/- 5.74), (11.8 +/- 8.33), and (19.9 +/- 7.53) x 10(6)/ml, the average total sperm counts were (65.6 +/- 13.71), (28.0 +/- 15.86), and (69.2 +/- 28.59) x 10(6), and the mean rates of progressively motile sperm were (22.3 +/- 3.18), (11.0 +/- 9.77), and (15.8 +/- 5.05)%, respectively. The success rates of bilateral vasoepididymostomy that involved the epididymal head, body, tail, and all the three parts were 62.5, 72.22, 60, and 54.55%, respectively. Natural pregnancy was achieved in 8 (10.53%) of the total number of cases.

CONCLUSIONMicrosurgery is effective for the treatment obstructive azoospermia. Unilateral vasoepididymostomy + unilateral vasovasostomy is superior to the other procedures, followed by bilateral vasoepididymostomy. Bilateral vasoepididymostomy involving the epididymal body may achieve a slightly better effect than that involving the other epididymal parts.

Adult ; Anastomosis, Surgical ; methods ; Azoospermia ; etiology ; surgery ; Epididymis ; surgery ; Female ; Humans ; Infertility, Male ; surgery ; Male ; Microsurgery ; Pregnancy ; Pregnancy Rate ; Sperm Count ; Treatment Outcome ; Vas Deferens ; surgery ; Vasovasostomy ; methods

OBJECTIVETo investigate the incidence of depression and its etiological factors in patients with cryptorchidism 6-16 years after surgical treatment.

METHODSUsing Self-Rating Depression Scale and Correlation Factor Questionnaire, we investigated the incidence of depression symptoms among 70 patients with cryptorchidism 6-16 years after surgical treatment and another 70 healthy males as controls, and analyzed the related factors of depression symptoms.

RESULTSThe incidence rate of depression symptoms was 50% in the cryptorchidism patients postoperatively, extremely significantly higher than 4.3% in the control group (χ2 = 23.5, P <0.01). Multiple stepwise regression analysis showed that the main risk factors of depression symptoms were worries about natural fertility (F = 15.8992, P <0.01), dissatisfaction with scrotal appearance (F = 4.6003, P <0.05), and the status of being married (F = 4.1002, P <0.05).

CONCLUSIONSymptoms of depression often occur in cryptorchidism patients after operation, and the major etiological factors are infertility, dissatisfaction with scrotal appearance, and the status of being married.

Adult ; Body Image ; psychology ; Case-Control Studies ; Cryptorchidism ; psychology ; surgery ; Depression ; epidemiology ; etiology ; Female ; Humans ; Incidence ; Infertility, Male ; psychology ; Male ; Marital Status ; Multivariate Analysis ; Risk Factors ; Scrotum ; pathology ; Surveys and Questionnaires ; Time Factors

PURPOSE: It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism. MATERIALS AND METHODS: Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertalpatients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score. RESULTS: Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5. CONCLUSIONS: Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.
Adolescent ; Adult ; Aged ; Alkaline Phosphatase/metabolism ; Biomarkers, Tumor/metabolism ; Carcinoma in Situ/diagnosis/*etiology/pathology ; Cryptorchidism/*complications/surgery ; Disease Progression ; Humans ; Infertility, Male/etiology ; Isoenzymes/metabolism ; Male ; Middle Aged ; Neoplasms, Germ Cell and Embryonal/diagnosis/*etiology/pathology/prevention & control ; Orchiectomy ; Puberty ; Retrospective Studies ; Spermatogenesis ; Testicular Neoplasms/diagnosis/*etiology/pathology/prevention & control ; Young Adult

Varicocele is the most common cause of male infertility and is generally correctable or at least improvable by various surgical and radiologic techniques. Therefore, it seems simple and reasonable that varicocele should be treated in infertile men with varicocele. However, the role of varicocele repair for the treatment of subfertile men has been questioned during the past decades. Although varicocele repair can induce improvement of semen quality, the obvious benefit of spontaneous pregnancy has not been shown through several meta-analyses. Recently, a well-designed randomized clinical trial was introduced, and, subsequently, a novel meta-analysis was published. The results of these studies advocate that varicocele repair be regarded as a standard treatment modality in infertile men with clinical varicocele and abnormal semen parameters, which is also supported by current clinical guidelines. Microsurgical varicocelectomy has been regarded as the gold standard compared to other surgical techniques and radiological management in terms of the recurrence rate and the pregnancy rate. However, none of the methods has been proven through well-designed clinical trials to be superior to the others in the ability to improve fertility. Accordingly, high-quality data from well-designed studies are needed to resolve unanswered questions and update current knowledge. Upcoming trials should be designed to define the best technique and also to define how to select the best candidates who will benefit from varicocele repair.
*Fertility ; Humans ; Infertility, Male/*etiology/surgery ; Male ; Urologic Surgical Procedures, Male/*methods ; Varicocele/complications/*surgery

Male infertility due to obstructive azoospermia is a well-known entity. It is characterised by obstruction to the outflow of sperms either in the epididymis, vas, seminal vesicles or the ejaculatory ducts. We describe a rare case of obstructive azoospermia due to compression of the ejaculatory duct and seminal vesicle by a large lower ureteric stone in a 30-year-old man who had infertility for the past ten years. The patient's azoospermia resolved after removal of the stone.
Adult ; Azoospermia ; diagnosis ; etiology ; therapy ; Constriction, Pathologic ; diagnosis ; Ejaculatory Ducts ; physiopathology ; Humans ; Infertility, Male ; diagnosis ; etiology ; therapy ; Male ; Seminal Vesicles ; physiopathology ; Sperm Count ; Tomography, X-Ray Computed ; Ureteral Calculi ; complications ; diagnosis ; surgery

Varicocele is a most common and surgically correctable cause of male infertility, for which varicocelectomy is the major treatment. Recent years have witnessed a lot of efforts devoted to the pathomechanism of varicocele-induced male infertility and rapid progress in researches on its cellular and molecular mechanisms, mainly including apoptotic abnormality and oxidative stress of germ cells. Meanwhile, researchers are coming to a consensus on the indications of varicocelectomy as well as the advantages and disadvantage of different methods of the procedure. This review updates the cellular and molecular mechanisms of varicocele-induced male infertility and its clinical therapeutic strategies.
Humans ; Infertility, Male ; etiology ; surgery ; Male ; Varicocele ; complications ; surgery

Glutathione S-transferases (GSTs), superoxide dismutase 2 (SOD2) and NAD(P)H:quinone oxidoreductase 1 (NQO1) are anti-oxidant enzyme genes. Polymorphisms of GSTs, SOD2 and NQO1 have been reported to influence individual susceptibility to various diseases. In an earlier study, we obtained preliminary findings that a subset of glutathione S-transferase T1 (GSTT1)-wt patients with varicocele may exhibit good response to varicocelectomy. In this study, we extended the earlier study to determine the distribution of genotype of each gene in the infertile population and to evaluate whether polymorphism of these genes affects the results of surgical treatment of varicocele. We analyzed 72 infertile varicocele patients, 202 infertile patients without varicocele and 101 male controls. Genotypes of GSTs were determined by polymerase chain reaction (PCR). Genotyping of SOD2 and NQO1 was performed using the PCR-restriction fragment length polymorphism (PCR-RFLP) method. A significantly better response to varicocelectomy was found in patients with the GSTT1-wt genotype (63.2%) and NQO1-Ser/Ser genotype (80.0%) than in those with GSTT1-null genotype (35.3%) and NQO1-Pro/Pro or NQO1-Pro/Ser genotype (45.2%), respectively. The frequencies of glutathione S-transferase M1/T1, SOD2 and NQO1 genotypes did not differ significantly among the varicocele patients, idiopathic infertile patients and male controls. GSTT1 genotype is associated with improvement of semen parameters after varicocelectomy. As the number of patients with NQO1-Ser/Ser genotype was not sufficient to reach definite conclusions, the association of NQO1 genotype with varicocelectomy requires further investigation.
Adult ; Genotype ; Glutathione Transferase ; genetics ; Humans ; Infertility, Male ; etiology ; genetics ; surgery ; Male ; NAD(P)H Dehydrogenase (Quinone) ; genetics ; Polymorphism, Genetic ; Predictive Value of Tests ; Superoxide Dismutase ; genetics ; Treatment Outcome ; Varicocele ; complications ; genetics ; surgery