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Re: Adolescent Varicocele: Improved Sperm Function After Varicocelectomy
MALE INFERTILITY
1995
mean, the observations suggest a possible mechanism warranting further study along the lines of the aforementioned randomized controlled trial reported by Abdel-Meguid et al. Craig Niederberger, M.D.
Re: Adolescent Varicocele: Improved Sperm Function After Varicocelectomy J. I. Lacerda, P. T. Del Giudice, B. F. da Silva, M. Nichi, R. M. Fariello, R. Fraietta, A. E. Restelli, C. G. Blumer, R. P. Bertolla and A. P. Cedenho Department of Surgery, Division of Urology, Human Reproduction Section, Sao Paulo Federal University, Sao Paulo, Brazil Fertil Steril 2011; 95: 994 –999.
Objective: To assess the effect of varicocelectomy on sperm function (DNA integrity and mitochondrial activity) and levels of lipid peroxidation in seminal plasma of adolescents. Design: Prospective study. Setting: Patients recruited from a local public school. Patient(s): Adolescents (14 –19 years old), Tanner stages IV or V with varicocele grades II or III, attending a local public school. Intervention(s): Two semen collections with a one week interval between collections before bilateral varicocele repair using subinguinal microsurgical varicocelectomy, and two semen collections with a one week interval between collections three months after the surgery. Main Outcome Measure(s): Rate of sperm DNA fragmentation as assessed by the Comet assay and categorized as classes I (no DNA fragmentation) to IV (high DNA fragmentation). Rate of mitochondrial activity as assessed by the diaminobenzidine assay and categorized as grades I (all mitochondria active) to IV (all mitochondria inactive). Levels of lipid peroxidation in seminal plasma by a colorimetric method that quantifies a lipid peroxidation subproduct (malondialdehyde). Result(s): Concerning DNA integrity, the samples after varicocelectomy showed more spermatozoa with intact nuclear DNA (grade I) and less spermatozoa with Comet grades II, III, and IV. Regarding mitochondrial activity, the samples after varicocelectomy showed less cells with inactive mitochondria (class III). No differences were observed in classes I, II, and IV. Concerning lipid peroxidation, no significant differences were observed. Conclusion(s): This study was able to demonstrate that varicocelectomy in adolescents is associated with increased sperm DNA integrity and mitochondrial activity. However, levels of seminal products of lipid degradation (malondialdehyde) are not different. Editorial Comment: Varicoceles arise in adolescence, and it is during this period of life that treatment might have the best effect if we could specifically select which varicoceles to fix. These investigators observed improvement in sperm DNA integrity using a stratified comet assay after varicocelectomy in adolescents, suggesting a way in which we might assess which adolescent varicoceles merit treatment. However, before we can jump to that use, we need a well designed, randomized, controlled trial to determine the magnitude of improvement in DNA integrity with varicocele treatment in this patient population. Craig Niederberger, M.D.
Re: Beneficial Effects of Microsurgical Varicocelectomy on Semen Parameters in Patients who Underwent Surgery for Causes Other Than Infertility S. Y. Cho, T. B. Kim, J. H. Ku, J. S. Paick and S. W. Kim Department of Urology, Seoul National University Hospital, Seoul, Korea Urology 2011; 77: 1107–1110.
Objectives: To evaluate whether clinical varicoceles are associated with abnormal semen parameters and whether varicocelectomy could improve the parameters in patients with causes other than infertility. Methods: A total of 268 adult men with clinical varicocele underwent microsurgical varicocelectomy resulting from causes other than infertility. A retrospective analysis of total sperm count, total motile sperm count, sperm concentration, motility, and morphology were performed. Results: Of 268 patients, at least 1 abnormal parameter (concentration, motility, or morphology) was
1995
mean, the observations suggest a possible mechanism warranting further study along the lines of the aforementioned randomized controlled trial reported by Abdel-Meguid et al. Craig Niederberger, M.D.
Re: Adolescent Varicocele: Improved Sperm Function After Varicocelectomy J. I. Lacerda, P. T. Del Giudice, B. F. da Silva, M. Nichi, R. M. Fariello, R. Fraietta, A. E. Restelli, C. G. Blumer, R. P. Bertolla and A. P. Cedenho Department of Surgery, Division of Urology, Human Reproduction Section, Sao Paulo Federal University, Sao Paulo, Brazil Fertil Steril 2011; 95: 994 –999.
Objective: To assess the effect of varicocelectomy on sperm function (DNA integrity and mitochondrial activity) and levels of lipid peroxidation in seminal plasma of adolescents. Design: Prospective study. Setting: Patients recruited from a local public school. Patient(s): Adolescents (14 –19 years old), Tanner stages IV or V with varicocele grades II or III, attending a local public school. Intervention(s): Two semen collections with a one week interval between collections before bilateral varicocele repair using subinguinal microsurgical varicocelectomy, and two semen collections with a one week interval between collections three months after the surgery. Main Outcome Measure(s): Rate of sperm DNA fragmentation as assessed by the Comet assay and categorized as classes I (no DNA fragmentation) to IV (high DNA fragmentation). Rate of mitochondrial activity as assessed by the diaminobenzidine assay and categorized as grades I (all mitochondria active) to IV (all mitochondria inactive). Levels of lipid peroxidation in seminal plasma by a colorimetric method that quantifies a lipid peroxidation subproduct (malondialdehyde). Result(s): Concerning DNA integrity, the samples after varicocelectomy showed more spermatozoa with intact nuclear DNA (grade I) and less spermatozoa with Comet grades II, III, and IV. Regarding mitochondrial activity, the samples after varicocelectomy showed less cells with inactive mitochondria (class III). No differences were observed in classes I, II, and IV. Concerning lipid peroxidation, no significant differences were observed. Conclusion(s): This study was able to demonstrate that varicocelectomy in adolescents is associated with increased sperm DNA integrity and mitochondrial activity. However, levels of seminal products of lipid degradation (malondialdehyde) are not different. Editorial Comment: Varicoceles arise in adolescence, and it is during this period of life that treatment might have the best effect if we could specifically select which varicoceles to fix. These investigators observed improvement in sperm DNA integrity using a stratified comet assay after varicocelectomy in adolescents, suggesting a way in which we might assess which adolescent varicoceles merit treatment. However, before we can jump to that use, we need a well designed, randomized, controlled trial to determine the magnitude of improvement in DNA integrity with varicocele treatment in this patient population. Craig Niederberger, M.D.
Re: Beneficial Effects of Microsurgical Varicocelectomy on Semen Parameters in Patients who Underwent Surgery for Causes Other Than Infertility S. Y. Cho, T. B. Kim, J. H. Ku, J. S. Paick and S. W. Kim Department of Urology, Seoul National University Hospital, Seoul, Korea Urology 2011; 77: 1107–1110.
Objectives: To evaluate whether clinical varicoceles are associated with abnormal semen parameters and whether varicocelectomy could improve the parameters in patients with causes other than infertility. Methods: A total of 268 adult men with clinical varicocele underwent microsurgical varicocelectomy resulting from causes other than infertility. A retrospective analysis of total sperm count, total motile sperm count, sperm concentration, motility, and morphology were performed. Results: Of 268 patients, at least 1 abnormal parameter (concentration, motility, or morphology) was