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Color Doppler ultrasound imaging in varicoceles: is the difference in venous diameter encountered during Valsalva predictive of palpable varicocele grade?

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Asian Journal of Urology 2023年第1期10卷 27-32页

作者： Kelly Lehner Catherine ingram Utsav Bansal Colleen Baca Adithya Balasubramanian Nannan Thirumavalavan Jason M.Scovell Saneal Rajanahally Matthew Pollard Larry I.Lipshultz Baylor College of Medicine Scott Department of UrologyHoustonTXUSA

Objective:The clinical grading system for varicoceles is subjective and dependent on clinician experience.Color Doppler ultrasound(US)has not been standardized in the diagnosis of varicoceles.We aimed to determine if US measurement of varicocele could be predictive of World Health Organization(WHO)varicocele grade.Methods:Men who presented for either scrotal pain or infertility to a tertiary men’s health clinic underwent physical examination,and varicoceles were graded following WHO criteria(0Zsubclinical,1,2,3).US was used to measure largest venous diameter in the pampiniform plexus bilaterally at rest and during Valsalva maneuver.Receiver operator characteristic curve analysis was used to determine if resting diameter,diameter during Valsalva,or change in diameter between at rest and during Valsalva provided the highest sensitivity and specificity for determining clinical grade.Threshold values for diameter were determined from these receiver operator characteristic curves.Results:A total of 102 men(50 with clinical varicocele and 52 with subclinical varicocele)were included.Diameter at rest was the best ultrasonographic discriminator between subclinical and clinical varicoceles(area under the curve[AUC]Z0.67)with a diameter threshold of 3.0 mm(sensitivity 79%,specificity 42%).Diameter during Valsalva had the greatest AUC for determining clinical Grades 1 versus 2(AUCZ0.57)with diameter threshold of 5.7 mm(sensitivity 71%,specificity 33%).For differentiating between Grades 2 and 3,diameter at rest had the greatest AUC of 0.65 with a threshold of 3.6 mm(sensitivity 71%,specificity 58%).Conclusion:Our results corroborate other studies that have shown a weak correlation between US and clinical grading.The use of diameter during Valsalva was less predictive than diameter at rest and was only clinically significant in differentiating between Grade 1 and 2 varicocele.A standardized method for determining clinically relevant varicoceles on US would allow for improved patient counseling and clinical decision-making.

关键词： Varicocele Ultrasound Doppler Venous plexus infertility

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The varicocele： diagnostic dilemmas, therapeutic challenges and future perspectives

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Asian Journal of Andrology 2016年第2期18卷 276-281,J0007页

作者： Koji Chiba Ranjith Ramasamy Dolores J Lamb Larry I.Lipshultz Center for Reproductive Medicine Baylor College of Medicine Houston TX USA Scott Department of Urology Baylor College of Medicine Houston TX USA Department of Molecular and Cellular Biology Baylor College of Medicine Houston TX USA.

A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. if a semen analysis is not obtained from the adolescent male, in the absence of other symptoms, the main clinical indication used by many urologists to recommend repair is testicular atrophy. The varicocele may result in testicular damage in some males causing testicular atrophy with impaired sperm production and decreased Leydig cell function, while in other males the varicocele may seemingly cause no ill effects. in adult men, varicoceles are frequently present and surgically correctable, yet the measurable benefits of surgical repair are slight according to a Cochrane review. While occurring more commonly in infertile men than fertile men, only 20% of men with a documented varicocele will suffer from fertility problems. Most varicoceles found in adolescents are detected during a routine medical examination, and it is difficult to predict which adolescent presenting with a varicocele will ultimately show diminished testicular function in adolescence or adulthood. As in adults, the mainstay of treatment for varicocele in adolescents is surgical correction. However, unlike an adult varicocelectomy （the microsurgical approach is the most common）, treatment for an adolescent varicocele is more often laparoscopic. Nevertheless, the goals of treatment are the same in the adolescent and adult patients. Controversy remains as to which patients to treat, when to initiate the treatment, and what type of treatment is the best. This review will present the current understanding of the etiology, diagnosis and treatment of the adolescent varicocele.

关键词： adolescent adult management varicocele

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Sperm retrieval and intracytoplasmic sperm injection outcomes in men with cystic fibrosis disease versus congenital bilateral absence of the vas deferens

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Asian Journal of Andrology 2021年第2期23卷 140-145页

作者： J Abram McBride Taylor P Kohn Daniel J Mazur Larry I.Lipshultz R Matthew Coward Scott Department of Urology Baylor College of MedicineHoustonTX 77030USA Department of Urology UNC School of MedicineChapel HillNC 27599USA UNC Fertility RaleighNC 27617USA

Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and intracytoplasmic sperm injection(iCSi)outcomes among men with cystic fibrosis(CF)disease and congenital bilateral absence of the vas deferens(CBAVD)only.We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic,high-volume andrology centers from 2010 to 2018.Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included.Differences between groups for CFTR abnormality,sperm retrieval,and iCSi outcomes were statistically analyzed.Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups.Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−1),P=0.02)and total motile sperm count(2.9 million vs 11.4 million,P=0.01).This difference was only predicted by homozygous delta F508 CFTR mutations(Pignificantly higher rate of rescue testicular sperm extraction(70.0%vs 27.6%,Pilization rate with iCSi(32.5%vs 68.9%,Pin conclusion,those with CF demonstrated lower sperm quality,greater difficulty with sperm retrieval,and worse iCSi outcomes compared with CBAVD-only patients.Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.

关键词： congenital bilateral absence of the vas deferens cystic fibrosis intracytoplasmic sperm injection outcomes male infertility obstructive azoospermia

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The importance of understanding baseline reproductive function prior to the administration of exogenous testosterone

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Asian Journal of Andrology 2016年第3期18卷 381-381页

作者： Jason R Kovac Larry I.Lipshultz Men's Health Center 8240 Naab Road Suite 220 Indianapolis Indiana 46260USA Scott Department of Urology Baylor College of Medicine Houston Texas77030 USA

Recent increases in the awareness of hypogonadism as a clinical condition have led to more men being managed with testosterone supplementation therapy （TST）. While highly effective at raising serum testosterone levels and controlling the symptoms of hypogonadism such as fatigue and low energy,1 the resultant suppression of the hypothalamic-pituitary-gonadal axis can lead to an inhibition of gonadotropins, including follicle-stimulating hormone （FSH） and luteinizing hormone （LH） and subsequent azoospermia.

关键词： @@

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Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction

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Asian Journal of Andrology 2017年第1期19卷 39-42页

作者： Jason R Kovac Ryan P Smith Miguel Cajipe Dolores J Lamb Larry I.Lipshultz Center of Reproductive Medicine and the Department of Molecular and Cellular Biology Scott Department of Urology Baylor College of Medicine Houston TX USA Department of Urology University of Virginia Charlottesville VA USA.

in couples with infertility, abnormal strict morphology of 0% normal forms （NF） is a criterion to proceed rapidly to in vitro fertilization （iVF）. Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies （ART）. A cohort of 24 men with 0% NF were identified （2010-2013） with 27 randomly selected men with 〉4% NF as controls. Patient charts were reviewed with men contacted and administered an institutional Review Board （iRB）-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy （controls = 55.6%, P〈 0.05）. When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require iVF （controls - thirty pregnancies; 76.7% did not require iVF）. The average age of men and female partners was similar between men with 0% NF and 〉4% NF. All men had normal follicle-stimulating hormone （FSH）, testosterone, prolactin, sex hormone-binding globulin （SHBG）, and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception （NC）, 100% of men with 0% NF （n = 7/7） and 37.5% of controls in = 3/8） went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without iVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. in men with 0% NF, alternative modalities should be considered before immediate iVF.

关键词： conception infertility intrauterine insemination in vitro fertilization strict morphology success

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性腺功能减退患者的生育能力保护：研究进展

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Asian Journal of Andrology 2015年第2期17卷 197-200,I0006,I0007页

作者： Ranjith Ramasamy Joseph M Armstrong Larry I.Lipshultz Department of Urology Baylor Collegesssss of Medicine Houston TX USA.

越来越多的年轻人和中年人有治疗性腺功能减退症（雄激素含量缺乏相关症状）的需求，其症状包括抑郁症，性冷淡，勃起功能障碍，疲劳。然而，睾酮补充疗法（包括使用天然和合成的类固醇）引起的睾丸功能衰退的患者人数正在增加，特别是... 详细信息

越来越多的年轻人和中年人有治疗性腺功能减退症（雄激素含量缺乏相关症状）的需求，其症状包括抑郁症，性冷淡，勃起功能障碍，疲劳。然而，睾酮补充疗法（包括使用天然和合成的类固醇）引起的睾丸功能衰退的患者人数正在增加，特别是那些年轻的运动员，外源性类固醇的使用对这些人的睾丸功能产生了消极影响。外源性睾酮治疗可以影响下丘脑垂体性腺轴的自然调节，造成生精功能受损，可能会导致严重后果，例如无精子症等男性不育症。对于那些患有性腺功能减退症的育龄男性，选择治疗方法时，保护生育能力很重要。研究显示，人绒毛膜促性腺激素（HCG）不仅可以治疗那些睾酮补充疗法引起的无精子症，还有助于维持升高的睾丸内睾酮水平。此外，选择性雌激素受体调节剂常与人绒毛膜促性腺激素联合使用治疗性腺功能减退症，该疗法不仅可以提高总睾酮水平，还有助于保护这些患者的生精功能。

关键词：人绒毛膜促性腺激素选择性雌激素受体调节剂精子发生睾酮补充治疗

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Sperm morphology and reproductive success

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Asian Journal of Andrology 2016年第3期18卷 402-402页

作者： Jason R Kovac Larry I.Lipshultz Men's Health Center 8240 Naab Road Suite 220 Indianapolis Indiana 46260USA Scott Department of Urology Bayler College of Medicine HoustonTexas 77030 USA.

Drs. Sikka and Hellstromi provide an excellent summary focusing on the basics of the endocrine evaluation of male fertility with a detailed look at the specifics of semen analyses. Discussing details such as concentration, motility and morphology, Sikka and Hellstrom expand on how these tests are conducted in a laboratory setting. An understanding of these particulars is valuable to the Andrologist who must subsequently synthesize these reports and relay them to patients in a simplistic manner.

关键词： VARiCOCELECTOMY

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Factors to consider for informed consent prior to vasectomy reversal

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Asian Journal of Andrology 2016年第3期18卷 372-372页

作者： Jason R Kovac Larry I.Lipshultz Men's Health Center 8240 Naab Road Suite 220 Indianapolis Indiana 46260USA Scett Department of Urology Baylor College of Medicine Houston Texas77030 USA.

The manuscript by Drs. Patel and Smith1 presents an excellent summary on the preoperative work up for patients undergoing vasectomy reversal （VR）, and describs factors that help predict success such as surgeon skill/experience, shorter obstructive interval, a partner＇s positive fertility history and younger female age53 While intraoperative decision-making is discussed in the text, it is important to ask why, with all the research available, do some physicians still feel comfortable only offering a vasovasostomy （VV）, irrespective of the microscopic characteristics of the vasal effluent.

关键词： @@

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The importance of sexual function in men with spinal cord injuries

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Asian Journal of Andrology 2016年第3期18卷 391-391页

作者： Jason R Kovac Larry I.Lipshultz Men's Health Center 8240 Naab Road Suite 220 Indianapolis Indiana 46260USA Scott Department of Urology Baylor College of Medicine Houston Texas77030 USA

Spinal cord injuries （SCis） are often devastating to patients and their families. in those men young enough to consider families and unfortunate enough to be unable to ejaculate, multiple options exist. The attached manuscript by Dr. ibrahim et al. contains a detailed outline of a multitude of techniques available to the Andrologist to both evoke ejaculation and harvest sperm from these patients. The authors, pioneers in the field of male fertility research for SCi patients, detail very high success rates for penile vibratory stimulation （86% success if above T10, 15% if below） and electroejaculation （91.9% success）.

关键词： @@

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Use of testicular sperm to combat the negative effects of DNA fragmentation

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Asian Journal of Andrology 2016年第3期18卷 434-434页

作者： Jason R Kovac Larry I.Lipshultz Men's Health Center 8240 Naab Road Suite 220 Indianapolis Indiana 46260USA Scott Department of Urology Baylor College of Medicine HoustonTexas 77030 USA.

Numerous approaches to the detection of novel biomarkers for male fertility have been proposed. As reviewed in the manuscript by Bieniek et al.analysis of seminal plasma has yielded numerous possible candidate biomarkers. Since semen analysis is a critical component in the initial workup for infertile males, seminal fluid biomarkers inherently have several distinct advantages.

关键词： HUMAN SPERMATOZOA EFFiCiENT TREATMENT iNFERTiLiTY iCSi MATURATiON iNTEGRiTY SUBSETS DAMAGE

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