Wos Açık Erişimli Yayınlar
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Item Impact Of Varicocele Repair On Semen Parameters In Infertile Men: A Systematic Review And Meta-Analysis(2023) Ceyhan, Erman; 36326166Purpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls.Materials and Methods: A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies).Results: A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I2=97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I2=97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I2=98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I2=97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I2=98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI-0.242 to 0.868; I2=89.7%).Conclusions: This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies' practice recommendations favoring VR to improve conventional semen parameters in infertile men.Item Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations(2023) Ceyhan, Erman; Magsanoc, Nikko; 35791302Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological As-sociation [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/ uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the re-sponses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identi-fied where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male in-fertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical prac-tice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.Item Transurethral Resection of Ejaculatory Duct in Primary Infertile Men with Distal Ejaculatory Duct Obstruction(2019) Ozer, Cevahir; Goren, Mehmet Resit; 0000-0001-6037-7991; 0000-0002-7850-6912; 0000-0002-2001-1386; AAM-2222-2020; Y-6143-2019Objective: We evaluated the outcome of transurethral resection for the treatment of distal ejaculatory duct obstruction with primary infertile men. Materials and Methods: We retrospectively evaluated 23 primary infertile men, who had distal ejaculatory duct obstruction, between June 2006 and July 2018. All patients were treated by transurethral resection of the ejaculatory duct. Results: The mean age of the patients was 31.82 +/- 5.01 years. Preoperative and postoperative seminal parameters were compared. There was a statistically significant increase in ejaculate volume, sperm concentration, sperm motility and total motile sperm count. Conclusion: Transurethral resection of the ejaculatory duct improved sperm parameters in most of the primary infertile men with distal ejaculatory duct obstruction. Transurethral resection may also decrease the need for assisted reproduction methods and allow in-vitro fertilization/intracytoplasmic sperm injection with ejaculated sperm in some azoospermic patients.Item Varicocelectomy in Patients with Non-obstructive Azoospermia(2019) Ozer, Cevahir; Goren, Mehmet Rasit; Gul, Umit; Tunc, Tahsin; Guvel, Sezgin; 0000-0001-6037-7991; AAM-2222-2020Objective: We evaluated the outcomes of varicocelectomy in men with non-obstructive azoospermia (NOA) and a palpable varicocele. Materials and Methods: We retrospectively evaluated 25 male patients with NOA having a palpable varicocele, between May 2006 and December 2018. Age, duration of infertility, testicular volume, grade and side of varicocele, varicocelectomy technique, and serum follicle-stimulating hormone, serum luteinizing hormone and serum testosterone levels were analyzed. Results: The mean age of the patients was 30.68 +/- 3.91 years. Of the 25 patients, 5 (20%) had motile sperm in the ejaculate in the postoperative semen analysis. There were no predictive factors affecting the appearance of the sperm in the ejaculate. Conclusion: Varicocelectomy should be considered a treatment option for men with NOA having a palpable varicocele.Item Distribution and number of Cajal-like cells in testis tissue with azoospermia(2017) Hasirci, Eray; Turunc, Tahsin; Bal, Nebil; Goren, Mehmet Resit; Celik, Huseyin; Kervancioglu, Enis; Dirim, Ayhan; Tekindal, Mustafa Agah; Ozkardes, Hakan; 0000-0002-7936-2172; 0000-0003-2898-485X; 0000-0002-2001-1386; 0000-0002-7277-449X; 0000-0002-4060-7048; 0000-0002-4147-2966; 0000-0003-3465-9092; 28359405; ABD-4332-2020; AAJ-5689-2021; Y-6143-2019; AAH-1052-2020; U-9270-2018; AAI-7997-2021; AAA-3033-2021; AAM-4475-2021We investigated the number and distribution of Cajal-like cells in patients with azoospermia. A total of 99 patients with non-obstructive azoospermia were divided into subgroups [19 patientsin hypospermatogenesis group (S1), 40 patients in maturation arrest group (S2), 20 patients in a Sertoli cell-only syndrome (S3), and 20 patients in a testicular atrophy and fibrosis group (S4)], and 20 patients with obstructive azoospermia group (SO). Sections stained with a c-kit antibody were studied by light microscopy to determine the number and distribution of Cajal-like cells in peritubular and perivascular areas of testis. The number of Cajal-like cells were higher in all the non-obstructive groups than in the obstructive group (S0: 2.43 cells/mm(2), S1: 3.14 cells/mm(2), S2: 4.00 cells/mm(2), S3: 4.57 cells/mm(2), S4: 3.86 cells/mm(2)) but statistically significantly different (p < 0.05) in the S2 and S3 subgroups only. Distribution of Cajal-like cells were similar in all groups. The number and distribution of Cajal-like cells in non obstructive groups suggest that these cells may affect spermatogenesis. This cellular type can be responsible for the regulation of cellular motility or spermatogenesis. Electrophysiological and electron microscopic studies are needed to better define morphology and function of Cajal-like cells in the testis, especially totally the normal testis tissue. Copyright (C) 2017, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.