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2008, Number 5

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Rev Med Inst Mex Seguro Soc 2008; 46 (5)

Fertility Prognosis Associated to Percutaneous Testicular Biopsy in Infertile Varicocele Patients

Juárez-Albarrán AC, Tene-Pérez CE, Maldonado- Villaseñor I, Casillas-Mesina R

Language: Spanish
References: 88
Page: 543-550
PDF size: 129.76 Kb.


ABSTRACT

Background: varicocele is cause of fertility disorders. The objective was to evaluate usefulness of testicular percutaneous biopsy in the fertility prognosis in patients, who undergone varicocelectomy.
Methods: a cohort study of 50 patients having undergone varicocelectomy due to varicocele was carried out. Five groups were formed according to testicular damage evaluated by percuta-neous biopsy (stage I through V histological lesions). Pregnancy rate and sperm count results were evaluated per group. ANOVA and Fisher exact test were used.
Results: patients aged 30.5 ± 5 years. Spermatic density and motility had improved one year after varicocelectomy. Pregnancies were achieved 13 ± 9 months later. Fifteen patients impregnated their partners. Fourteen of them (93 %) had stage I, II or III histological damage and only one case had stage IV. Pregnancy probability was greater in the stage I, II or III testicular damage (OR = 9.3, 95 % CI = 11-79, p ‹ 0.021).
Conclusions: the proposed histological classification of testicular damage allows evaluating fertility prognosis as well as the magnitude of testicular damage in patients with varicocele.


REFERENCES

  1. Jarow JP, Sharlip ID, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, Schegel PN, Howards SS, Nehra A, Damewood MD, Overstreet JW, Sadovsky R. Best practice policies for male infertility. J Urol 2002;167:2138-2144.

  2. Tulloch SW, Varicocele in subfertility, in milestone in Urology. J Urol 2001;166(6):2032-2033.

  3. Kibar Y, Seckin B, Erdnuran D. The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters. J Urol 2002;168:1071-1074.

  4. Hopps CV, Lemer ML, Schegel PN, Goldstein M. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol 2003;170:2366-2370.

  5. Sigman M, Jarow SP. Varicocele, Genital examination. En: Wein, Kavoussi, Novick, Partin P, editors. Campbell-Walsh Urology. Ninth edition. US: WB Saunders; 2007. p. 609-653.

  6. Esteves SC, Glina S. Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. Int Braz J Urol 2005;31:514-518.

  7. Liphultz L, Thomas AJ, Khera M. Surgical management of male infertility. En: Wein, Kavoussi, Novick, Partin, Peters, editors. Campbell-Walsh Urology. Ninth edition. US: WB Saunders; 2007. p. 654-716.

  8. Jarow JP, Coburn M, Sigman M. Incidence of varicoceles in men with primary and secondary infertility —in adult urology—. Urology 1996;47: 73-76.

  9. Marmar JL, Benoff S. The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome (andrology). Human Reprod 2005;20(8):2279-2288.

  10. Marmar J, Benoff S. Editorial: New scientific information related to varicoceles. J Urol. 2003;170: 2371-2373.

  11. Seftel AD, Rutchik SD, Chen H, Stovsky M Goldfarb J, Desai N. Effects of subinguinal varicocele ligation on sperm concentration, motility and Kruger morphology. J Urol l997;158:1800-1803.

  12. Guarch R, Pesce C, Puras AS, Lázaro J. Quantitative approach to the classification of hypoespermatogenesis in testicular biopsies for infertility. Human Pathol 1992; 23:1032-1037.

  13. Daitch JA, Bedaiwy MA, Pasqualotto EB, Hendin BN, Hallak J, Falcone T, Thomas AJ, Nelson DR, Agarwal A. Varicocelectomy improves intrauterine insemination success rates in men with varicocele. J Urol 2001;165(5):1510-1513.

  14. Lin WW, Abrams J, Lipshultz LI, Kim ED. Image analysis assessment of testicular force preparation of cytologies effectively quantifies human spermatogenesis. J Urol l998;160:1334-1336.

  15. Harrington TG, Shauer D, Gilbert BR. Percutaneous testis biopsy, an alternative to open testicular biopsy in the evaluation of the subfertile men. J Urol 1996;156(5):1647-1651.

  16. Carpi A, Menchini F, Gorini LI, Gaet P, Romani R, Marchetti A. A percutaneous large-needle aspiration biopsy technique for histologic examination of the testis in infertile patients. Techniques and instrumentation. Fertil Steril 1999;71(4):756- 760.

  17. Pesce SM. The testicular biopsy in the evaluation of male infertility. Semin Diagn Pathol 1987;4(4): 264-274.

  18. Hadzizelimovic LB, Da Runga D, Buser MW. The value of testicular biopsy in patients with varicocele. J Urol 1986;135:707-710.

  19. Adjfes JH, Van der Vijer JC, Schenck PE. Value of a testicular biopsy rating for prognosis in oligozoospermia. Br Med J 1978;41:289-290.

  20. Schoysman R. The interest of testicular biopsy in the study of male infertility. Acta Eur Fertil 1980; 11(1):1-32.

  21. Altay B, Hsekimgil M, Kefi A, Girgin C, Cikili N. A comparison of the histopathological findings after open and percutaneous needle testicular biopsy in adult male rats. BJU Int 2000;86(9): 1084-1087.

  22. Krause W, Muller HH, Schafer H, Weidner W. Does treatment of varicocele improve male fertility?: results of the “Deutsche Varikozelenstudie”, a multicentre study of 14 collaborating centres. Andrologia 2002;34(3):164-171.

  23. Chan PTK, Schiegel PN. Diagnostic and therapeutic testis biopsy. Curr Urol Rep 2000;1:266-272.

  24. Chen CS, Harrington TG, Schauer D, Gilbert BE. Percutaneous testis biopsy: an alternative to open testicular biopsy in the evaluation of the subfertile man. J Urol 1997;158:1527.

  25. Sharlip ID, Chan SL. Testicular biopsy and vasography. En: Hellstrom WJG, editor. Male infertility and sexual disfunction. US: Springer; 1997. p. 174-188.

  26. Jow WW. Testis biopsy. Urol Clin North Am 1997: 8-25.

  27. McLachlan RI, De Meyts ER, Hansen CEH, de Kretser DM, Skakkebaeck NE. Histological evaluation of the human testis —approaches to optimizing the clinical value of the assessment: mini review. Human Reproduction 2007;22(1): 2-16.

  28. Weiss DB, Rodríguez RL, Smith KD, Chowdhuri A, Steinberber E. Quantitation of Leydig cells in testicular biopsies of oligospermic men with varicocele. Fertil Steril 1978;30(3):395-412.

  29. Elliot SP, Orejuela F, Hirsch IH, Lipshultz LI, Lamb SD, Kim ED. Testis biopsy findings in the spinal cord injured patient. J Urol 2000;163:792-795.

  30. Kim ED, Leibman BB, Grinblat DM, Lipshultz LI. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 1999 162:737-740.

  31. Dawson SB, Trapp RG. Bioestadística médica. Segunda edición. México: El Manual Moderno; 1997.

  32. Shefi S, Turek PJ. Definition and current evaluation of subfertile men. Int Braz J Urol 2006;32(4):385-397.

  33. Lipshultz LI. Subfertility, infertility and sterility. En: Kauffman JJ, editor. Current urologic therapy. Second edition. US: WB Saunders; 1986. p. 73-76.

  34. Kamal KM, Javi K, Zini A. Microsurgical varicocelectomy in the era of assisted reproductive technology: Influence of initial semen quality on pregnancy rates. Fertil Steril 2001;75 (5):1013-1016.

  35. Hopps CV, Lemer ML, Schegel PN, Goldstein M. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol 2003;170:2366-2370.

  36. Johnsen SG, Agger P. Quantitative evaluation of testicular biopsies before and after operation for varicocele. Fertil Steril 1999;71(4):756-760.

  37. Ashhok A, Tamer MS. Oxidative stress, DNA damage and apoptosis in male infertility: a clinical approach (Mini-reviews). BJU Int 2005;95(4):503-507.

  38. Abdelrahim F, Mostafa A, Hamdy A, Mabrouk M, el-Kholy M, Hassan O. Testicular morphology and function in varicocele patients: pre-operative and post-operative histopathology. Br J Urol 1993;72 (5 pt 1):643-647.

  39. Heargreave TB; WHO Task force on the prevention; management of infertility. The World Health Organization Varicocele Trial 160. Br J Urol 1996; 77(Suppl 1):39.

  40. Marmar JJ, Benoff S. Varicoceles. J Urol 2006;175: 818-819.

  41. Wolski JK, Kluge P, Kaziol K, Lewandowsky P, Biarda B, Wyascki J. Needle testicular biopsy in the diagnosis of male infertility. Ginecol Pol 1998;69(6): 541-544.

  42. Morey AF, MacDonald MF, Rozansky TA, Narajan S, Thompson IM. Yield and efficacy of biopsy gun testis needle biopsy. Urology 1999;53(3):604-607.

  43. Amelar RD. Early and late complications of inguinal varicocelectomy. J Urol 2003;170:366-369.

  44. Zini A, Fischer A, Bellack D, Nopss M, Kamal K, Chow V, Mak V. Technical modification of microsurgical varicocelectomy can reduce operating time. Urology 2006;67:803-806.

  45. Jarow JP, Sharlip ID, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, Schegel PN, Howards SS, Nehra A, Damewood MD, Overstreet JW, Sadovsky R. Best practice policies for male infertility. J Urol 2002;167:2138-2144.

  46. Tulloch SW, Varicocele in subfertility, in milestone in Urology. J Urol 2001;166(6):2032-2033.

  47. Kibar Y, Seckin B, Erdnuran D. The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters. J Urol 2002;168:1071-1074.

  48. Hopps CV, Lemer ML, Schegel PN, Goldstein M. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol 2003;170:2366-2370.

  49. Sigman M, Jarow SP. Varicocele, Genital examination. En: Wein, Kavoussi, Novick, Partin P, editors. Campbell-Walsh Urology. Ninth edition. US: WB Saunders; 2007. p. 609-653.

  50. Esteves SC, Glina S. Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. Int Braz J Urol 2005;31:514-518.

  51. Liphultz L, Thomas AJ, Khera M. Surgical management of male infertility. En: Wein, Kavoussi, Novick, Partin, Peters, editors. Campbell-Walsh Urology. Ninth edition. US: WB Saunders; 2007. p. 654-716.

  52. Jarow JP, Coburn M, Sigman M. Incidence of varicoceles in men with primary and secondary infertility —in adult urology—. Urology 1996;47: 73-76.

  53. Marmar JL, Benoff S. The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome (andrology). Human Reprod 2005;20(8):2279-2288.

  54. Marmar J, Benoff S. Editorial: New scientific information related to varicoceles. J Urol. 2003;170: 2371-2373.

  55. Seftel AD, Rutchik SD, Chen H, Stovsky M Goldfarb J, Desai N. Effects of subinguinal varicocele ligation on sperm concentration, motility and Kruger morphology. J Urol l997;158:1800-1803.

  56. Guarch R, Pesce C, Puras AS, Lázaro J. Quantitative approach to the classification of hypoespermatogenesis in testicular biopsies for infertility. Human Pathol 1992; 23:1032-1037.

  57. Daitch JA, Bedaiwy MA, Pasqualotto EB, Hendin BN, Hallak J, Falcone T, Thomas AJ, Nelson DR, Agarwal A. Varicocelectomy improves intrauterine insemination success rates in men with varicocele. J Urol 2001;165(5):1510-1513.

  58. Lin WW, Abrams J, Lipshultz LI, Kim ED. Image analysis assessment of testicular force preparation of cytologies effectively quantifies human spermatogenesis. J Urol l998;160:1334-1336.

  59. Harrington TG, Shauer D, Gilbert BR. Percutaneous testis biopsy, an alternative to open testicular biopsy in the evaluation of the subfertile men. J Urol 1996;156(5):1647-1651.

  60. Carpi A, Menchini F, Gorini LI, Gaet P, Romani R, Marchetti A. A percutaneous large-needle aspiration biopsy technique for histologic examination of the testis in infertile patients. Techniques and instrumentation. Fertil Steril 1999;71(4):756-760.

  61. Pesce SM. The testicular biopsy in the evaluation of male infertility. Semin Diagn Pathol 1987;4(4): 264-274.

  62. Hadzizelimovic LB, Da Runga D, Buser MW. The value of testicular biopsy in patients with varicocele. J Urol 1986;135:707-710.

  63. Adjfes JH, Van der Vijer JC, Schenck PE. Value of a testicular biopsy rating for prognosis in oligozoospermia. Br Med J 1978;41:289-290.

  64. Schoysman R. The interest of testicular biopsy in the study of male infertility. Acta Eur Fertil 1980; 11(1):1-32.

  65. Altay B, Hsekimgil M, Kefi A, Girgin C, Cikili N. A comparison of the histopathological findings after open and percutaneous needle testicular biopsy in adult male rats. BJU Int 2000;86(9): 1084-1087.

  66. Krause W, Muller HH, Schafer H, Weidner W. Does treatment of varicocele improve male fertility?: results of the “Deutsche Varikozelenstudie”, a multicentre study of 14 collaborating centres. Andrologia 2002;34(3):164-171.

  67. Chan PTK, Schiegel PN. Diagnostic and therapeutic testis biopsy. Curr Urol Rep 2000;1:266-272.

  68. Chen CS, Harrington TG, Schauer D, Gilbert BE. Percutaneous testis biopsy: an alternative to open testicular biopsy in the evaluation of the subfertile man. J Urol 1997;158:1527.

  69. Sharlip ID, Chan SL. Testicular biopsy and vasography. En: Hellstrom WJG, editor. Male infertility and sexual disfunction. US: Springer; 1997. p. 174-188.

  70. Jow WW. Testis biopsy. Urol Clin North Am 1997: 8-25.

  71. McLachlan RI, De Meyts ER, Hansen CEH, de Kretser DM, Skakkebaeck NE. Histological evaluation of the human testis —approaches to optimizing the clinical value of the assessment: mini review. Human Reproduction 2007;22(1): 2-16.

  72. Weiss DB, Rodríguez RL, Smith KD, Chowdhuri A, Steinberber E. Quantitation of Leydig cells in testicular biopsies of oligospermic men with varicocele. Fertil Steril 1978;30(3):395-412.

  73. Elliot SP, Orejuela F, Hirsch IH, Lipshultz LI, Lamb SD, Kim ED. Testis biopsy findings in the spinal cord injured patient. J Urol 2000;163:792-795.

  74. Kim ED, Leibman BB, Grinblat DM, Lipshultz LI. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 1999 162:737-740.

  75. Dawson SB, Trapp RG. Bioestadística médica. Segunda edición. México: El Manual Moderno; 1997.

  76. Shefi S, Turek PJ. Definition and current evaluation of subfertile men. Int Braz J Urol 2006;32(4):385-397.

  77. Lipshultz LI. Subfertility, infertility and sterility. En: Kauffman JJ, editor. Current urologic therapy. Second edition. US: WB Saunders; 1986. p. 73-76.

  78. Kamal KM, Javi K, Zini A. Microsurgical varicocelectomy in the era of assisted reproductive technology: Influence of initial semen quality on pregnancy rates. Fertil Steril 2001;75 (5):1013-1016.

  79. Hopps CV, Lemer ML, Schegel PN, Goldstein M. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol 2003;170:2366-2370.

  80. Johnsen SG, Agger P. Quantitative evaluation of testicular biopsies before and after operation for varicocele. Fertil Steril 1999;71(4):756-760.

  81. Ashhok A, Tamer MS. Oxidative stress, DNA damage and apoptosis in male infertility: a clinical approach (Mini-reviews). BJU Int 2005;95(4):503-507.

  82. Abdelrahim F, Mostafa A, Hamdy A, Mabrouk M, el-Kholy M, Hassan O. Testicular morphology and function in varicocele patients: pre-operative and post-operative histopathology. Br J Urol 1993;72 (5 pt 1):643-647.

  83. Heargreave TB; WHO Task force on the prevention; management of infertility. The World Health Organization Varicocele Trial 160. Br J Urol 1996; 77(Suppl 1):39.

  84. Marmar JJ, Benoff S. Varicoceles. J Urol 2006;175: 818-819.

  85. Wolski JK, Kluge P, Kaziol K, Lewandowsky P, Biarda B, Wyascki J. Needle testicular biopsy in the diagnosis of male infertility. Ginecol Pol 1998;69(6): 541-544.

  86. Morey AF, MacDonald MF, Rozansky TA, Narajan S, Thompson IM. Yield and efficacy of biopsy gun testis needle biopsy. Urology 1999;53(3):604-607.

  87. Amelar RD. Early and late complications of inguinal varicocelectomy. J Urol 2003;170:366-369.

  88. Zini A, Fischer A, Bellack D, Nopss M, Kamal K, Chow V, Mak V. Technical modification of microsurgical varicocelectomy can reduce operating time. Urology 2006;67:803-806.




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