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Article
Laparoscopic Varicocelectomy for Bilateral Varicoceles in Infertile Males

Authors: Saad D. Farhan --- Muayed Abass Fadhel**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 317-322
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men presenting with infertility.Despite the very long history of the disease and many records on different surgical and radiological solutions, the ideal method of spermatic vein ligation for varicocele is still a matter of controversy. The perfect technique would be one that preserves testicular function and eliminates the varicocele with a low rate of recurrence, hydrocele formation and any other complications.OBJECTIVE:To assess the efficacy of laparoscopic Varicocelectomy for management of bilateral palpable varicoceles in infertile males.METHODS:We analysed the result of 25 patients presented with history of infertility and diagnosed to have bilateral palpable varicoceles treated in our department with Bilateral laparoscopic ligation of the spermatic vessels between January 2009 and November 2010.RESULTS:The average operative (Bilateral Laparoscopic Varicocelectomy) time was 34 minutes. There were no intra operative complications in the study group. Hydrocele formation was seen in 3 (6%) patients recurrence was seen in one (2%) patient .The average hospital stay was 18 hours. postoperative analgesics (1-2) doses , daily activities initiation usually started after 48 hrs and physical exercise 72 hrs . non of the patient has developed an atrophic testis as a result of the laparoscopic procedure. eighteen patients (72% )of the patients had improvement of the seminal fluid parameters During follow up period (6 months),with seminal fluid analysis, clinical and ultrasonic examination.CONCLUSION:Laparoscopic varicocele ligation is a simple and safe technique, causing minimal morbidity and enabling rapid return to normal activity


Article
Chronic testicular pain a clinico-pathological study

Author: Abdul Salaam Al-Masri عبد السلام المصري
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2006 Volume: 32 Issue: 1&2 Pages: 41-45
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To evaluate the clinico-pathological spectrum and treatment of chronic testicular pain patients.
Methods: A prospective and descriptive case series study, conducted at the out-patient clinic of the department of urology at Al Jumhoury teaching hospital in Mosul, between Jan2000 and Dec 2005. The parameters analyzed include; character of the pain, onset, and duration, patient’s age, occupation, past surgical and medical history, the clinical examination, the investigations and treatment.
Results: Forty five patients were studied, their age ranged from (16 – 68) years, twenty (44%) patients were under the age of 30 years, ten (22%) patients were between (31 - 45) years, and fifteen (34%) patients were above (46) years of age.
The presenting symptom was chronic scrotal pain for more than three months, which is differing in its onset, duration and description. The pain was mainly at the left side, eight (18%) patients had positive clinical findings, 17(38%) patients had positive ultrasonographic pathological findings.
The treatment ranged from psychological (reassurance), physical (antibiotic with chronic analgesia) to surgical intervention for those with positive lesion proved by physical examination and investigations.
Conclusion: Chronic testicular pain patients remain as dilemma to the general practitioners and frustrating clinical problem for urologists.

Key words: Chronic testicular pain, ultrasonography, Varicocele.


Article
The Value of Routine Scrotal Color Doppler Ultrasonography in the infertile male

Authors: Hayder M. AL-Aridy --- Hayder Q . AL-Mosawi --- Hayder Abd Aun
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2012 Volume: 8 Issue: 14 Pages: 111-122
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Clinical assessment of scrotal contents in patients with infertility has relied mainly on physical examination.Color Doppler ultrasonography (US) is generally not performed as a routine examination. However, physical examination might miss many abnormalities readily detected by US, including testicular tumor and testicular microlithiasis (TM). We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men compared with findings by physical examination.Scrotal Color Doppler ultrasonography was performed in 314 infertile men with a mean age of (25±5.4) years to detect intrascrotal abnormalities. Findings were compared with those of physical examination.Intrascrotal abnormalities were detected by ultrasonography in 86.6% of patients. Of 374 abnormalities, 31% were undetected by physical examination. Left varicocele was found in 234 patients (74%); testicular microlithiasis in 10 (3.1%);epididymal cyst in 23 (7.3%); right varicocele in 7(2.2%); and testicular cysts in 2 (0.6%). One occurrence (0.3%) was found for testicular tumor, hypoechoic small testicles in 11(3.2%), and hydrocele in 45(14.3%).Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 77%. Sensitivity of physical examination in detecting left varicocele compared with to US was decreased as grade of left varicocele decreased.The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men,frequently detecting non-palpable lesions that were missed by physical examination.

التقييم السريري لمحتويات كيس الصفن لدى مرضى العقم غالبا ما تعتمد على الفحص السريري حيث ان فحص الدوبلر الملون بالموجات فوق الصوتية لا يجرى بشكل روتيني لهم مما قد يؤدي الى عدم تشخيص الكثير من الحالات المرضية و التي تكون سببا مباشرا للعقم الذي يعانون منه. في بحثنا هذا قمنا بتقييم دور الفحص بالموجات فوق الصوتية لكيس الصفن و محتوياته كفحص روتيني لجميع المرضى الذين يعانون من العقم مقارنين النتائج بتلك التي نحصل عليها بواسطة الفحص السريري التقليدي. لقد شمل البحث 314 شخصا مصابا بالعقم حيث تم كشف حوالي 374 مشكلة مرضية لديهم بواسطة فحص الموجات فوق الصوتية في حين ان 31% من هذة المشاكل لم يتم كشفها بواسطة الفحص السريري و التي هي غالبا ما تكون دوالي الخصية من الدرجة البسيطة ,قيلة مائية,اكياس البربخ ,اورام الخصية الصغيرة اضافة الى ان الفحص السريري لا يمكنه التنبؤ بطبيعة نسيج الخصية. الفحص الروتيني بواسطة الامواج فوق الصوتية لكيس الخصية لدى مرضى العقم هو ذو قيمة عالية في تحديد الكثير من الامراض التي لا يمكن للفحص السريري الكشف عنها.


Article
The Outcome of Varicocelectomy on Sperm Parameters in Subfertile Men with Clinical Varicoceles Who Have Asthenozoospermia and or Teratozoospermia with Normal Sperm Count

Authors: Mohammed Ali Ghadhban --- Ahmed Abdulameer Alwan
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2016 Volume: 12 Issue: 22 Pages: 106-109
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Design Of Study: prospective study.Duration: From 2014 to 2015Setting: Department of Urology, AL-Diwaniya teaching Hospital, Infertility clinic.Patients & Methods: Over a period of one year hundred (100) patients with varicocele associated with male infertility over a 3-years period were included in this study. Pre- and postvaricocelectomy seminal fluid parameters evaluation according to the World Health Organization (WHO) criteria was performed at 6-month intervals.General anesthesia was given to all patients.Results:One hundred patients met the criteria their age range from 25 to 45 years with a mean age of 32± 3 years. The mean duration of infertility was 3years (range: 1.5–6).). Only the sperm motility of patients with normospermia showed a significant improvement postoperativelyConclusion:No significant improvement in sperm morphology may be obtained inpatients with clinical varicocele and preoperative normospermia.


Article
Scrotal Doppler ultrasound during evaluation for infertility

Authors: Abdul Salaam Al-Masri عبد السلام المصري --- Hazim H. Al Salih حازم حميد
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2006 Volume: 32 Issue: 1&2 Pages: 46-50
Publisher: Mosul University جامعة الموصل

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Abstract

Aim: the aim of the study is to clarify the incidental intra scrotal pathological findings during evaluation of infertile males depending on the clinical examination and Doppler ultrasonic scanning.
Patients and methods: A prospective case series study conducted in the radiology department of Al Batool teaching hospital from Feb. 2000 – Feb. 2003, where most of the patients referred from the infertility unit of the same hospital and evaluated by Doppler ultrasonographic scanning with (SIEMENS, SONOLINE Versa Pro, 7.5 MHz Linear array transducer) in supine and some times in erect position.
Results: The data of 1660 patients analyzed to different pathologies, their ages ranged from (18-60) years with mean of 23 years. One thousand and four hundreds sixty patients (88%) were primarily infertile and two hundreds patients (12%) were secondarily infertile, seven hundreds and sixty six patients (46%) had abnormal findings on clinical and ultrasonic examinations of their genitalia, while nine hundreds and sixteen patients (54%) were normal. The distribution and the frequency of different discovered abnormalities were studied; varicocele was found in (42.7%) of the patients and followed by testicular atrophy in (33.8%).
Conclusion: Varicocele and testicular atrophy are the most common causes of primary as well as secondary male infertility and the color Doppler US is superior to physical examination in evaluating patients with infertility.

Key words: infertility, testicular atrophy, varicocele, color Doppler ultrasound


Article
Sub- Inguinal Varicocelectomy in the Treatment of Infertile Males with Varicoceles

Author: Murtadha M.S.Majeed Al-Musafer
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 323-327
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Varicocele is an abnormal dilatation of pampiniform plexus within the spermatic cord. Varicoceles are present in 15% of the normal male population and in up to 35-40% of patients with infertility. In approximately 70-81% of patients with secondary infertility, a varicocele is an underlying cause. It is a disease of puberty and is only rarely detected in boys less than ten years of age.OBJECTIVE:Is to evaluate the sub inguinal approach of varicocelectomy in infertile males with grade II and III varicoceles.METHODS:A total of 150 patients were included in the study from 2004 to May 2010. Their ages ranged from 18 to 42 years. Fifty patients (33.3%) had grade II while 100 (66.6%) patients had grade III varicoceles. All the patients had history of more than one year infertility (ranging from 14 to 36 months) and all of them were sexually competent. Physical examination was performed with no apparent other clinical cause of infertility. Although varicoceles were diagnosed primarily by physical examination, color Doppler ultrasound was done for further documentation of the patient's condition. Only patients with grade II and grade III primary varicoceles were included in the study with exclusion of those with grade I varicoceles. Seminal fluid analysis and hormonal assay were done for all patients. Any patient with sperm concentration below 10 millions / milliliter was also excluded. Sub inguinal varicocelectomy was done for each patient. The operative time ranged from 20-25 minutes. The patients were followed for one year.RESULTS:The overall pregnancy rate at one year was 66, 6 % .The time from the operation till pregnancy was ranged from 4 to 12 months. Ten patients ( 6.6% ) developed recurrence , 2 patients ( 1.3% ) developed scrotal pain for 3 weeks postoperatively and then disappeared , and only 4 patients ( 2.6 % ) developed hydrocele .CONCLUSION:Whereas most male infertility surgeons now use the microsurgical approach, varicocele repairs can be achieved with successful results and minimal complications without microsurgery as long as they are carefully performed. Although microscopic sub inguinal varicocelectomy is better than non microscopic one, the later can be done successfully with shorter operative time


Article
EVALUATION OF SEMINAL FLUID PARAMETERS AFTER IN VITRO SPERM PREPARATION TECHNIQUE IN NON VARICOCELIC AND VARICOCELIC INFERTILE MEN UNDERGOING VARICOCELECTOMY

Authors: Basim Khamees Gootee باسم خميس --- Diyaa Abed Auda ضياء عبد عودة
Journal: Thi-Qar Medical Journal مجلة ذي قار الطبية ISSN: 19929218 Year: 2012 Volume: 6 Issue: 1 Pages: 151-162
Publisher: Thi-Qar University جامعة ذي قار

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Abstract

This study was designed to evaluate and compare the results of semen parameters, sperm membrane potential integrity and viability for non varicocelic and varicocelic infertile men after varicocelectomy. Thirty semen samples (varicocelic) and twenty normozoospermic men (non varicocelic) as a control group were collected by masturbation in the special semen room collection and prepared by simple layering technique. The semen samples were analyzed and prepared by standard semen parameters. Furthermore, sperm concentration, sperm motility, progressive sperm motility, sperm agglutination, normal sperm morphology, sperm HOST, and sperm Eosin stain were evaluated according to standard WHO criteria (1999). However, direct immunobead assay was used to determine the presence of AS-AB bound on sperm surface. For preparation technique, sperm prepared and incubated for 30 minute in 5% CO2 at 37ºC after in vitro sperm processing. The results of the present study indicate a highly significant (P<0.001) differences in all sperm functions parameters of varicocelic infertile men in AS-ABs positive (HOST and Eosin stain; negative) as compare with that noticed in normozoospermic men in AS-AB negative (HOST and Eosin stain; positive). It was concluded that there are a strong positive correlation between varicocele and antisperm antibodies generation and between antisperm antibodies and semen characteristics and HOST-Vitality test. Further studies are recommended to assess the detrimental effect of AS-ABs on DNA damage and embryo quality after in vitro fertilization and embryo transfer in assisted reproductive technologies (IVF-ET-ART).


Article
THE EFFECT OF ASSISTED REPRODUCTIVE TECHNOLOGY AND SPERM ACTIVATION TECHNIQUES ON SEMEN CHARACTERISTICS AND PREGNANCY RATES
تأثير التقنيات المختبرية و تنشيط النطف المساعدة على الإنجاب في متغيرات تحليل السائل المنوي ومعدلات الحمل

Author: باسم خميس الركابي
Journal: Iraqi Journal of Biotechnology المجلة العراقية للتقانات الحياتية ISSN: 18154794 Year: 2010 Volume: 9 Issue: 2 Pages: 158-166
Publisher: Baghdad University جامعة بغداد

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Abstract

This study was designed to assess the effect of sperm activation techniques In vitro on semen characteristics and intrauterine insemination (IUI) procedure in varicocelic infertile patients. In this study, fifty infertile male involved and according to preparation methods divided into 25 varicocelic and 25 non-varicocelic infertile couples. From each male, semen samples were analyzed before and after in vitro sperm processing by standard semen parameters. However, the spermatozoa prepared by direct swim-up and centrifugation swim-up technique with addition of IVF culture medium. Furthermore, sperm concentration, sperm motility, progressive sperm motility and normal sperm morphology were evaluated according to WHO standard criteria. For IUI technique, sperm prepared and incubated for 30 minute in 5% CO2 at 37ºC. The results of the present study indicate a highly significant (P<0.001) differences for all sperm functions and pregnancy rates (P<0.001) were reported post in vitro sperm activation using direct swim-up and centrifugation swim-up method as compared to pre-activation. Whereas, the best results for clinical pregnancy rate were reported for semen samples prepare by using direct swim-up when compared with centrifugation swim-up method. It was concluded that centrifugation force have detrimental effect on sperm plasma membrane activity and fertilization potential of human spermatozoa. Further studies are recommended to evaluate the detrimental effect of centrifugation swim-up technique on DNA damage and embryo quality after in vitro fertilization and embryo transfer.

تهدف هذه الدراسة إلى تقييم تاثير تقنيات تنشيط النطف على متغيرات تحليل السائل المنوي ومعدلات الحمل بعد اجراء تقنية التلقيح الاصطناعي داخل الرحم لمرضى العقم المصابين بدوالي الخصية. تضمنت هذه الدراسة 50 مريضاً تم تقسيمهم إلى 25 مصاباً بدوالي الخصية و 25 غير مصاب. تم تحضير وتحليل للسائل المنوي قبل وبعد إجراء عملية تنشيط النطف خارج الجسم إعتماداً على المتغيرات القياسية. تم تحضير عينة السائل المنوي بطريقتين الأولى النظرية الطباقية البسيطة والثانية طريقة النبذ المركزي باضافة وسط تحضير النطف أثناء الحضن. أن فحوصات كفاءة النطف والتي تتضمن تركيز النطف و حركة النطف و الحركة التقدمية للنطف و النسبة المئوية للنطف السوية تم تقييمها وفقاً إلى مقررات منظمة الصحة العالمية. تم وضع النطف التي تم تنشيطها لغرض استعمالها في تقنية التلقيح الاصطناعي عبر الرحم في الحاضنة لمدة 30دقيقة في 5% ثاني اوكسيد الكاربون وبدرجة حرارة37 ْم. أظهرت النتائج ارتفاعاً P<0.001 معنوياً عالياً في معايير السائل المنوي ومعدلات الحمل بعد التنشيط وبكلا طريقتي تحضير النطف مقارنة بقبل التنشيط, إذ تم الحصول على أفضل النتائج باستعمال النظرية الطباقية البسيطة مع وسط تحضير النطف مقارنة بطريقة النبذ المركزي. استنتج من الدراسة الحالية ان قوة النبذ المركزي لها تأثير ضار في كفاءة الغشاء البلازمي وقابلية الاخصاب للنطفة البشرية. نوصي باجراء دراسات لتقييم التأثير الضار لقوة النبذ المركزي على ضرر الحامض النووي ونوعية الاجنة بعد اجراء تقنيات الاخصاب الخارجي ونقل الأجنة.


Article
Assessment of Sperm DNA Fragmentation for Patients Suffering from Varicocele

Authors: Saif H. Mohammed --- Adib M. Al-Kazzaz --- Usama S.Al- Nasiri
Journal: Iraqi Journal of Embryos and Infertility Researches المجلة العراقية لبحوث الأجنة والعقم ISSN: eISSN: 26166984 / pISSN: 22180265 Year: 2014 Volume: 4 Issue: 2 Pages: 47-52
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Varicocele is an abnormal dilation of the testicular veins in the pampiniform plexusand characterized by retrograde blood flow in the internal spermatic veins due toincompetent or absent valves. It is considered one of the main causes of male factorinfertility. Sperm DNA integrity is essential for in vivo and in vitro fertilization, andvaricocele causes a progressive decrease in sperm quality .Objective:To study the impact of varicocele on semen quality and sperm DNAintegrity.Patients, Materials and Methods:Twenty patients with varicocele and 20 men without varicocele were assigned intotwo groups in the Out-Patient Clinic of Urology in Al-Kadhimya Teaching Hospital. Semen was collected from both groups and the rate of sperm DNA fragmentationassessed by the "Comet assay" and categorized to 4 classes. Class I (no DNAfragmentation), class II (little DNA fragmentation), class III (meaningful DNAfragmentation), and class IV (high DNA fragmentation) .Results: No statistically significant differences were found between the varicoceleand control groups with respect to age. Men with varicocele had significantlyhigher ejaculate volume, lower sperm concentration, and lower progressive motility,and showed more abnormal morphology than men in the control group. TheVaricocele group showed a lower percentage of sperm with little DNAfragmentation (class II) and a higher percentage of sperm with DNAfragmentation (class IV), than the control group.Conclusions:Compared with men without varicocele, men with varicocele had a higherpercentage of cells with DNA fragmentation .


Article
Changes in seminal antioxidant defenses in Iraqi patients with unilateral and bilateral varicocele

Author: Issam Salman Al-Azzawi
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 1 Pages: 1-7
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background : The exact pathogenic mechanism by which varicoceles cause impaired testicular function remains poorly understood . One of the possible mechanisms is the generation of seminal oxidative stress. In addition, the impact of bilateral varicocele on spermatogenesis is still poorly studied . Aims : To study the changes in seminal antioxidant defenses in relation to unilateral and bilateral varicocele, and to correlate them with changes in sperm concentration and total motility. Patients and methods : A prospective, randomized, controlled study , whereby 60 semen samples were collected and analyzed. Twenty samples were from healthy subjects , having no varicocele ( control group ), 20 samples from patients with unilateral varicocele and 20 samples from patients with bilateral varicocele . For each semen sample, measurement of the seminal concentration of the antioxidants ( Albumin, Glutathione peroxidase and Superoxide dismutase ) was done and the seminal concentration of the oxidative stress marker, Malondialdehyde. In addition sperm concentration and total motility were also estimated. Comparison of the results in the 3 groups was done . Results : Measurement of semen parameters revealed a drop in the mean value of the 3 antioxidants and an increase in the mean value of Malondialdehyde, which was statistically significant in the 2 varicocele groups in comparison with control, and in bilateral varicocele in comparison with unilateral varicocele . Another drop was in the mean sperm concentration and mean percentage of sperm total motility, which was statistically significant in the 2 varicocele groups in comparison with control, but was statistically not significant between the 2 varicocele groups . Conclusions : Bilateral varicocele causes more significant drop in seminal antioxidant defenses than unilateral varicocele which seems to add a more negative impact on spermatogenesis .

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