Approximately 15% of men in the general population have varicoceles, and varicoceles are diagnosed in 40% of men presenting for fertility evaluations. One percent of men in the general population are azoospermic, and 15% of men presenting for fertility evaluations are diagnosed with azoospermia. This article aims to review the impact of varicoceles on testicular function in men with azoospermia, the impact of varicocele repair on the semen parameters of azoospermic men, and the impact of varicocele repair on sperm retrieval and pregnancy outcomes when the male partner remains azoospermic after varicocele repair.
Humans ; Varicocele/physiopathology* ; Azoospermia/physiopathology* ; Male ; Pregnancy ; Female ; Sperm Retrieval ; Semen Analysis ; Pregnancy Outcome ; Testis/physiopathology*

Varicocele, the most common and treatable cause of male infertility, significantly impacts fertility. The pathophysiological mechanisms of varicocele have not been fully understood yet. Recent studies have focused on the pathophysiology of varicocele-induced infertility, highlighting inflammation and oxidative stress as key contributing factors. We reviewed recent research on the roles of inflammation and oxidative stress in the pathophysiology of varicocele and found that they negatively impact semen parameters, spermatogenesis, and testicular and epididymal function. In addition, this article summarizes the related factors of inflammation and oxidative stress caused by varicocele. Finally, a brief consideration on the treatments to address inflammation and oxidative stress is proposed. This review may provide treatment options and targets for varicocele-induced infertility. However, the relationship between inflammation and oxidative stress in varicocele still needs further study.
Varicocele/physiopathology* ; Humans ; Oxidative Stress/physiology* ; Infertility, Male/metabolism* ; Male ; Inflammation/physiopathology* ; Spermatogenesis/physiology*

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.
Diagnosis, Differential ; Epididymitis/*diagnosis/drug therapy ; Humans ; Male ; Pain/*diagnosis ; *Pain Management ; Pain, Postoperative ; Physical Examination ; *Scrotum ; Spermatic Cord Torsion/*diagnosis/surgery ; Testis/physiopathology ; Varicocele/*diagnosis/physiopathology/therapy ; Vasectomy

OBJECTIVETo investigate the influence of varicocele (VC) on semen parameters and the concentration of inhibin B in the serum and seminal plasma of VC men.

METHODSWe collected semen and peripheral blood samples from 95 infertile VC patients and 55 normal fertile men. We performed semen routine examination by computer-assisted semen analysis and sperm morphology examination by modified Papanicolaou staining, and measured the levels of inhibin B in the peripheral blood and seminal plasma of the subjects by ELISA.

RESULTSCompared with the normal fertile controls, the infertile men with grade-I, -II and -III VC showed significantly lower percentages of morphologically normal sperm ([7.5 +/- 5.2]% vs [6.3 +/- 6.5]%, [2.6 +/- 3.0]% and [1.0 +/- 0.7]%, P < 0.05) and progressively motile sperm ([43.9 +/- 22.7]% vs [33.3 +/- 20.8]%, [28.9 +/- 19.8]% and [13.5 +/- 8.4]%, P < 0.05). The majority of the morphologically abnormal sperm were of the type of head deformity. The concentrations of inhibin B in the peripheral blood and seminal plasma were evidently lower in the infertile men with grade-I VC ([160.9 +/- 48.9] pg/ml and [208.3 +/- 28.1] pg/ml), grade-II VC ([150.6 +/- 44.7] pg/ml and [201.5 +/- 83.5] pg/ml), and grade-III VC ([132.6 +/- 41.5] pg/ml and [150.2 +/- 51.6] pg/ml) in comparison with those of the fertile control group ([201.0 +/- 38.1] pg/ml and [225.3 +/- 82.5] pg/ml).

CONCLUSIONVaricocele reduces sperm motility, increases sperm abnormality, decreases the concentration of inhibin B in the serum and seminal plasma, and consequently damages male fertility.

Adult ; Case-Control Studies ; Humans ; Infertility, Male ; physiopathology ; Inhibins ; blood ; metabolism ; Male ; Semen ; cytology ; metabolism ; Semen Analysis ; Sperm Motility ; Varicocele ; blood ; metabolism

PURPOSE: It has been reported that varicocele is found less frequently in obese men. Accordingly, we evaluated varicocele patients and statistically analyzed the correlation between varicocele and somatometric parameters. MATERIALS AND METHODS: A total of 211 patients underwent surgery for varicoceles. All patients underwent history taking, physical examination, and scrotal ultrasound to determine the presence and severity of varicocele. An age-matched control group consisted of 102 patients who were found not to have varicocele according to physical examinations and scrotal ultrasound. The age, weight, height, and body mass index (BMI) of the two groups were compared. The statistical analyses were performed by use of PASW Statistics ver. 18.0. A p-value of less than 0.05 was used for statistical significance. RESULTS: In the varicocele group, the mean age, height, weight, and BMI were 29.42+/-14.01 years, 168.53+/-9.97 cm, 62.14+/-13.17 kg, and 21.66+/-3.21 kg/m2, respectively. The distribution of varicocele grade was as follows: 103 (48.8%) grade III, 72 (34.1%) grade II, and 36 (17.1%) grade I. In the control group, the mean age, height, weight, and BMI were 30.83+/-17.31 years, 161.93+/-19.83 cm, 64.69+/-17.86 kg, and 24.04+/-3.64 kg/m2, respectively. Analyzing these data specifically in adolescents, they showed significant differences in age, height, and BMI (p=0.000, p=0.000, and p=0.004, respectively) between two groups. There were no significant differences in somatometric parameters between patients with different grades of varicocele. CONCLUSIONS: Our results showed that patients with varicoceles were significantly taller and had a lower BMI than did patients without varicoceles, especially among adolescents. Carefully designed future studies may be needed.
Adolescent ; Adult ; Anthropometry/methods ; Body Height/physiology ; Body Mass Index ; Body Weight/physiology ; Case-Control Studies ; Humans ; Male ; Scrotum/ultrasonography ; Varicocele/*etiology/physiopathology/ultrasonography ; Young Adult

OBJECTIVETo investigate the abnormal changes in the testes and semen parameters in patients with varicose veins and analyze the possible relationship between clinical varicocele and infertility.

METHODSWe retrospectively reviewed the records of 172 male patients consulting for varicocele in our hospital since 2003. All these patients were examined for the size of the testes with scrotal ultrasound. The semen samples of the patients with varicocele except for 5 under the age of 17 years were collected and analyzed, using the data of semen analyses of 163 healthy young male volunteers (aged 18-29 years) as control.

RESULTSAll the 172 patients had left-sided varicose veins. Sixty-three patients were found to have bilateral varicocele, and in most of them, the clinical grades of the left-sided varicose veins were higher than those of the right-sided ones. The mean volume of the left testis of the patients was 10.99∓3.71 ml, significantly smaller than that of the right one (11.86∓4.05 ml, P<0.01). The physiochemical indices of the patients, including the voiding volume, semen pH, liquefaction time and sperm concentration, were normal or similar with those of the healthy volunteers (P>0.05). Almost all the patients sperm motility and viability were significantly lower than those of the healthy volunteers (P<0.05). In addition, no significant difference was found in the sperm density, motility or viability between the patients with unilateral and bilateral varicocele (P>0.05).

CONCLUSIONVaricocele may decrease the testicular volume. Both unilateral and bilateral varicocele may have an effect on the bilateral testes to cause possible functional impairment of the testes manifested by decreased sperm motility and viability.

Adolescent ; Adult ; Child ; Humans ; Infertility, Male ; etiology ; Male ; Middle Aged ; Retrospective Studies ; Semen ; Sperm Count ; Sperm Motility ; Testis ; physiopathology ; Varicocele ; complications ; physiopathology ; Young Adult

OBJECTIVETo investigate the influence of varicocele on the volume discrepancy of bilateral testes, and the relationship between testicular volume discrepancy and semen parameters.

METHODSThis study included 181 varicocele patients and 102 normal fertile men without varicocele. We retrospectively analyzed their clinical data, including the grades and locations of varicocele, testis volume and semen parameters.

RESULTSBilateral testicular volume discrepancy was found in 132 (72.9%) of the varicocele patients (including 117 cases of left testicular hypotrophy [88.6%]), and 35 (34.3%) of the non-varicocele fertile men. The rates of bilateral testicular volume discrepancy were 61.3%, 3.5%, 20.9% and 14.3% in the grade-III, grade-II, grade-I and non-varicocele groups, respectively (P < 0.05), with statistically significant differences among different age groups (P < 0.05). The percentage of morphologically normal sperm and sperm motility were reduced differently with different degrees of testicular volume discrepancy (P <0.05).

CONCLUSIONTesticular volume discrepancy is more common in men with left varicocele, and its prevalence and degree are correlated with the grade of varicocele. Semen quality decreases with the increase of testicular volume discrepancy.

Adult ; Humans ; Male ; Organ Size ; Retrospective Studies ; Semen Analysis ; Sperm Count ; Sperm Motility ; Testis ; pathology ; Varicocele ; pathology ; physiopathology ; Young Adult

OBJECTIVETo detect the sperm plasma membrane integrity (PMI) of varicocele (VC) patients using SYBR-14/PI fluorescent staining and flow cytometry, and investigate its clinical significance.

METHODSWe collected semen samples from 120 men, including 30 grade-1 varicocele patients (VC1), 30 grade-2 (VC2), 30 grade-3 (VC3), and 30 normal fertile volunteer controls. Conventional semen analyses were performed by computer-assisted semen analysis (CASA). All the semen samples were washed with PBS and then subjected to SYBR-14/PI staining for the detection of sperm PMI by flow cytometry. The proportion of normal sperm with PMI was indicated as the percentage of sperm emitting green fluorescence (SYBR-14+/PI- %), sperm PMI was determined and sperm fertilization capacity predicted.

RESULTSSignificant differences were detected in SYBR-14+/PI- and SYBR-14-/PI+ between the normal men and varicocele male patients (P < 0.01). The percentages of the sperm with PMI (SYBR-14+/PI- %) were remarkably lower in the VC1, VC2 and VC3 groups ([54.85 +/- 3.78]%, [45.37 +/- 4.12]% and [35.14 +/- 4.91]%) than in the normal controls ([70.79 +/- 6.71]%). SYBR-14+/PI-% was correlated positively with sperm motility (r=0.965, P < 0.01) and the percentage of grade a + b sperm (r = 0.874, P < 0.01), negatively with the percentage of grade d sperm (r = -0.965, P <0.01), but not significantly with pH, semen volume and liquefaction time (P > 0.05).

CONCLUSIONSYBR-14/PI fluorescent staining and flow cytometry can quickly and exactly detect sperm PMI. Varicocele decreases sperm PMI, which might be an important cause of male infertility.

Case-Control Studies ; Cell Membrane ; pathology ; Flow Cytometry ; Humans ; Male ; Organic Chemicals ; Semen Analysis ; Sperm Motility ; Spermatozoa ; Staining and Labeling ; Varicocele ; pathology ; physiopathology

OBJECTIVETo detect sperm mitochondrial membrane potential (MMP) of varicocele patients and investigate its clinical significance.

METHODSSixty-seven varicocele patients were divided into a VC1 (grade 1, n = 26), a VC2 (grade 2, n = 21) and a VC3 group (grade 3, n = 20). And 29 normal fertile volunteers were included in a control group ( m = 29). Conventional semen analyses were performed by computer-assisted semen analysis (CASA). Semen samples were washed, followed by JC-1 staining to evaluate the sperm MMP (JC-1+ %) by flow cytometry.

RESULTSThe sperm MMPs of the VC1, VC2 and VC3 groups were siginificantly lower ([56.29 +/- 16.32]%, P < 0.05; [45.04 +/- 13.21]%, P < 0.01; [31.63 +/- 12.91]%, P < 0.01) than that of the control ([76.21 +/- 13. 96]%). There was a significant positive correlation between the percentage of JC-1+ and that of grade (a + b) sperm (r =0.693, P=0.000).

CONCLUSIONThe decreased MMP in the sperm of varicocele men might be one of the important causes of male infertility.

Adult ; Flow Cytometry ; Humans ; Male ; Membrane Potential, Mitochondrial ; Sperm Motility ; Spermatozoa ; physiology ; Varicocele ; metabolism ; physiopathology ; Young Adult

OBJECTIVETo investigate the effects of experimental left varicocele (ELV) on the expression of sperm associated antigen 11 (SPAG11) mRNA and its protein isomer SPAG11E in the testis and epididymis of adolescent rats, and to explore the mechanism of infertility caused by varicocele.

METHODSThe experimental left varicocele model was established in the adolescent male Sprague-Dawley rats. Two and 4 weeks after the operation, the changes of SPAG11 mRNA and SPAG11E expression in the testis and epididymis were detected using immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR).

RESULTSThe expected product of SPAG11 367 bp amplified by RT-PCR was detected only in the epididymis. SPAG11E protein was observed mainly in the acrosomal vesicles and acrosome of round and elongating spermatids of the seminiferous epithelium, in the cytoplasm of Leydig cells, and in the supranuclear region of principle cells and stereocilia of the epididymal epithelium. Imaging and statistical analysis showed that SPAG11 mRNA and SPAG11E protein expressions in the left epididymis of the 2- and 4-week ELV groups presented a remarkable decrease (P < 0.05 or P < 0.01) compared with the right side and the corresponding control group, and the same decreased change in the left epididymis (P < 0.05 or P < 0.01) and an obvious reduction of SPAG11E immunopositive reaction in the right epididymis (P < 0.01) were noted in the 4-week group as compared with the 2-week group. No statistical difference of SPAG11E expression in the bilateral testes was found (P > 0.05) between the ELV group and the control, as well as between the 2- and 4-week ELV groups.

CONCLUSIONSPAG11 is a specific gene expressed in the epididymis. The localization and expression of SPAG11E exhibited a region- and cell-specific pattern in both the testis and epididymis of adolescent rats. The expression levels of both SPAG11 mRNA and SPAG11E protein altered obviously in ELV rats. The results suggest that SPAG11 may not only play an important role in spermatogenesis and sperm maturation, but also be associated with varicocele-induced male infertility or subfertility.

Animals ; Antigens, Surface ; genetics ; metabolism ; Disease Models, Animal ; Epididymis ; metabolism ; Glycopeptides ; genetics ; metabolism ; Immunohistochemistry ; Male ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Testis ; metabolism ; Time Factors ; Varicocele ; physiopathology