Lower body mass index and higher height are correlated with increased varicocele risk

To evaluate the anthropometric indexes in subjects with varicocele compared to controls and the incidence of varicocele in different body mass index (BMI) groups for the purpose of exploring the association between varicocele and anthropometric indexes. A comprehensive literature search was conducted by using PubMed, MEDLINE, EMBASE databases and Cochrane Library up to February 2019. A systematic review and meta‐analysis was conducted by STATA, and Newcastle–Ottawa Scale was utilised for assessing risk of bias. Ultimately, 13 articles containing seven case–control studies and six cross‐sectional studies with 1,385,630 subjects were involved in our study. Pooled results demonstrated that varicocele patients had a lower BMI (WMD = ?0.77, 95% CI = ?1.03 to ?0.51) and a higher height than nonvaricocele participants, especially in grade 3 varicocele patients. Subgroup analyses showed that normal BMI individuals had a higher risk of varicocele than obese or overweight individuals and a lower risk than underweight individuals. In conclusion, this study indicates that varicocele patients have a lower BMI and a higher height than nonvaricocele participants. Moreover, men with excess bodyweight have a lower incidence of varicocele compared to normal weight or underweight people. That is to say, high BMI and adiposity protect against varicocele and high BMI is associated with a decreased risk of varicocele.     

实验性精索静脉曲张大鼠血清及睾内睾酮的变化

目的:研究精索静脉曲张(VC)大鼠模型对血清T和睾丸内T的影响。方法:通过部分结扎左肾静脉建立SD大鼠VC模型20只;假手术组SD大鼠20只为对照组。模型建立后4、8周取静脉血,并取部分睾丸组织匀浆提取上清液,放免法测定血清及睾丸内T浓度。结果:血清T:实验组4、8周与同期对照组相比有下降趋势,但没有统计学意义。双侧睾丸内T水平:实验组4周与对照组4周相比下降,但无统计学意义(P>0.05);实验组8周与对照组8周相比下降,具有统计学意义(P<0.01)。结论:在8周内实验性大鼠VC并没有引起血清T的降低,但可以导致双侧睾丸内T降低。     

中药生精冲剂对精索静脉曲张大鼠的治疗

目的：研究中药生精冲剂对大鼠精索静脉曲张的影响及疗效。方法：从80只SD雄性大鼠中随机抽出20只作为假手术组，余60只均建立精索静脉曲张病理模型后随机均分为模型组、生精冲剂组和克罗米芬组。造模后15d生精冲剂组和克罗米酚组分别给予生精冲剂4g/（kg·d）和克罗米芬20mg/（kg·d）灌胃，模型组和假手术组正常喂食。造模后45d放免法测定血清性激素（FSH、LH和T）及观察各组大鼠睾丸组织结构。结果：生精冲剂组大鼠光镜下睾丸组织结构优于模型组和克罗米芬组；血清FSH、LH生精冲剂组显著低于模型组和克罗米芬组（P〈0.05），而克罗米芬组显著高于其他3组。T在生精冲剂组、克罗米芬组和假手术组之间无显著差异，但均显著高于模型组（P〈0.05）。结论：中药生精冲剂对精索静脉曲张引起的睾丸损害有保护及修复作用，且可能优于克罗米芬。     

放射性核素阴囊血池显像技术诊断精索静脉曲张的临床研究

目的:探讨放射性核素阴囊血池显像(RSI)技术诊断精索静脉曲张(VC)的价值。方法:本组126例有男性不育1年以上病史、精液分析异常的患者分别接受临床体格检查(PE);RSI技术检查,计算两侧阴囊血池指数值(SBPI),并观察是否有精索静脉血液返流;以及彩色双功能多普勒显像(CDFI)检查,对VC进行分型、定度。将PE,RSI结果分别与CDFI结果对比。结果:PE、RSI诊断VC的灵敏度分别为:71.7%、96.5%,特异度分别为:69.1%、97.1%。RSI诊断VC的灵敏度、特异度均高于PE。结论:RSI技术是诊断临床型、亚临床型VC的简单、安全、有效的无创诊断方法,也是一种非侵袭性,更加客观、准确地诊断VC的有效方法。     

Incidence of the retroaortic left renal vein in patients with varicocele.

OBJECTIVE: The purpose of this study was to investigate the incidence of the retroaortic left renal vein (RLRV) in patients with varicocele. METHODS: The left renal vein was ultrasonographically investigated for the presence of the RLRV in 140 patients with varicocele and a control group of 137 age-matched patients. The main diagnostic criteria for varicocele were the presence of a varicose vein with a diameter of 3 mm or larger at rest and with a reflux lasting more than 2 seconds during the Valsalva maneuver. The RLRV was defined as a posterior course of the left renal vein to the aorta at the level of the origin of the superior mesenteric artery. RESULTS: The RLRV was observed in 13 (9.3%) of the 140 patients with varicocele and 3 (2.2%) of the control patients. The incidence of the RLRV was found to be significantly higher in patients with varicocele compared with the control patients (P = .018, Fisher exact test). In 13 patients with the RLRV, left varicocele and bilateral varicocele were detected in 10 and 3 cases, respectively. CONCLUSIONS: In this study, the incidence of the RLRV was found to be significantly higher in patients with varicocele compared with control patients. Thus, we suggest that the presence of the RLRV may be considered one of the etiologic factors in the development of varicocele.     

两微孔法腹腔镜下精索静脉曲张高位结扎53例

目的总结二微孔法腹腔镜下精索内静脉高位结扎的临床经验。方法二微孔法行腹腔镜下精索内静脉高位结扎术53例，其中左侧曲张39例，双侧陆张14例。结果患者手术均获成功，无并发症发生，平均手术时间30min，术后平均住院3d。结论二微孔法行腹腔镜下精索内静脉高位结扎术是一种可选的术式，患者痛苦小，损伤轻，恢复快，更具有美容、微创的治疗效果，操作难度不大。     

Varicocele--the most common cause of male factor infertility?

Varicocele is often cited as the most common cause of male factor infertility. Arguments in support of this statement include reports of increased prevalence of varicocele in populations of infertile men compared with fertile or otherwise unselected men, association of varicocele with abnormal semen parameters, and improvements in semen parameters and/or pregnancy rates after varicocele repair. Logically, there would appear to be three possibilities regarding the relationship between varicocele and fertility: (i) varicocele has no association with or effect on male fertility; (ii) varicocele may be associated with, but is not the cause of, male subfertility; and (iii) varicocele is a direct cause of male subfertility. In the following, we review evidence from the literature for and against these three possibilities: at the current time, available evidence appears inadequate to confirm or deny any of these three possibilities. Since the ultimate goal of infertile couples is to conceive, it seem logical that future varicocele research should focus primarily on adequately powered, controlled clinical trials in well-characterized infertile couples, randomized to intervention or appropriate controlled observation, with pregnancy as the primary outcome.     

诱导型一氧化氮合酶在精索静脉曲张大鼠睾丸中的表达

目的：探讨精索静脉曲张大鼠睾丸组织中诱导型一氧化氮合酶(iNOS)的表达与不育的关系。方法：选择30只成年SD大鼠,随机分为精索静脉曲张组20只,假手术组10只,应用免疫组织化学EnVision法检测iNOS在睾丸组织中的表达并测量曲细精管的直径,比较两者之间差异。结果：精索静脉iNOS的表达明显高于假手术组,差异有非常显著性意义,曲张组曲细精管的直径明显小于假手术组,差异有非常显著性意义。结论：精索静脉曲张大鼠睾丸组织中iNOS过度表达是导致不育的原因之一。     

The Nutraceutical N-Palmitoylethanolamide (PEA) Reveals Widespread Molecular Effects Unmasking New Therapeutic Targets in Murine Varicocele

Varicocele is an age-related disease with no current medical treatments positively impacting infertility. Toll-like receptor 4 (TLR4) expression is present in normal testis with an involvement in the immunological reactions. The role of peroxisome proliferator-activated receptor-α (PPAR-α), a nuclear receptor, in fertility is still unclear. N-Palmitoylethanolamide (PEA), an emerging nutraceutical compound present in plants and animal foods, is an endogenous PPAR-α agonist with well-demonstrated anti-inflammatory and analgesics characteristics. In this model of mice varicocele, PPAR-α and TLR4 receptors’ roles were investigated through the administration of ultra-micronized PEA (PEA-um). Male wild-type (WT), PPAR-α knockout (KO), and TLR4 KO mice were used. A group underwent sham operation and administration of vehicle or PEA-um (10 mg/kg i.p.) for 21 days. Another group (WT, PPAR-α KO, and TLR4 KO) underwent surgical varicocele and was treated with vehicle or PEA-um (10 mg/kg i.p.) for 21 days. At the end of treatments, all animals were euthanized. Both operated and contralateral testes were processed for histological and morphometric assessment, for PPAR-α, TLR4, occludin, and claudin-11 immunohistochemistry and for PPAR-α, TLR4, transforming growth factor-beta3 (TGF-β3), phospho-extracellular signal-Regulated-Kinase (p-ERK) 1/2, and nucleotide-binding oligomerization domain-like receptor (NLR) family pyrin domain-containing 3 (NLRP3) Western blot analysis. Collectively, our data showed that administration of PEA-um revealed a key role of PPAR-α and TLR4 in varicocele pathophysiology, unmasking new nutraceutical therapeutic targets for future varicocele research and supporting surgical management of male infertility.     

Protein profiling in unlocking the basis of varicocele-associated infertility

Varicocele is one of the major causes of male infertility and has a negative impact on spermatogenesis. The conventional semen analysis does not reveal the underlying subcellular mechanisms associated with defects in spermatozoa. Proteomics and bioinformatics analysis can be used to identify the molecular aetiologies associated with poor semen quality in varicocele patients. Mitochondrial dysfunction has been identified as the main factor affecting normal physiological functions of spermatozoa. This article discusses the proteomic studies of spermatozoa and seminal plasma in varicocele patients. Proteomics can identify potential spermatozoa and seminal plasma biomarkers in varicocele-mediated male infertility. In future, these protein biomarkers can be useful in the development of noninvasive diagnostic and therapeutic strategies for varicocele patients.