Patients With and Without Varicocele: Biochemical Markers

Patients With and Without Varicocele Biochemical MarkersDifferences in Biochemical Markers and Body Mass Index Between Patients With and Without VaricoceleBackground Varicocele is characterized by abnormal tortuosity and distension of the venous blood vessels of the pampiniform plexus within the sperm cellous stack and is one of the causes of male infertility. This guinea pig aimed to gauge the differences in bio- chemical markers and corpse mass index (BMI) mingled with patients with and without varicocele.Methods Between January 2004 and June 2009, 102 patients with varicocele (Group A) were evaluated. Ninety-five period-matched male patients who did non draw varicocele were selected as projects (Group B). Varicocele was diagnosed by physical examination and substantiate by Doppler ultrasonography. The range of ages was among 18 and 50 grades doddering. BMI, testosterone, blood serum basic phosphatase, calcium, lactic dehydrogenase, inorganic phosphate, -glutamine transpeptidase, uric acid, albumin, iron, cholesterol, triglyceride, alanine transaminase, and aspartate aminotrans- ferase levels were measured for all the subjects.Results The ungenerous age was 35.4 years in separate A and 36.5 years in group B. Of the 102 patients in group A, 20 were variant 1 varicocele, 55 were grade 2 and 27 were grade 3. The BMI (mean SD) of patients with varicocele (22.8 3.2) was importantly write down than that of patients without varicocele (24.9 4.1). Patients with varicocele had signifi bevelly trim serum levels of cholesterol than patients without varicocele (176.5 31.1 vs. 187.7 42.1 mg/dL). There were no significant differences for the former(a) biochemical markers between the groups. Patients with grade 3 varicocele had a clinical depressioner BMI than patients with grades 1 and 2 varicocele, but this was not significant. No significant differences were found for the another(prenominal)(a) biochemical markers among the patients with g rade 1, 2 or 3 varicocele.Conclusion Patients with varicocele had significantly start out serum levels of cholesterol than those without varicocele. In addition, the prevalence of varicocele was high in patients with a lower BMI. Our findings suggest that patients with a greater BMI may have advantages in relieving the nutcracker phenomenon, which causes significant varicoceles. J Chin Med Assoc 201073(4)194198Key Words biochemical markers, be mass index, testosterone, varicoceleIntroductionVaricocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes of male infertility. The prevalence of varicocele is approxi- mately 1520% in the general population and 3040% in infertile men.1 Furtherto a greater extent, approximately 6981%of men with substitute(prenominal) infertility have varicocele.2,3Levinger et al proposed that varicocele prevalence is increased all over cadence and the ri sk of incidence is approx- imately 10% for each decade of life.4 The definite eti- ology of varicocele is unflustered unknown. Kumanov et al suggested that weight and body mass index (BMI) have a protective role, and height, penile length and penile circumference were negative factors in the*Correspondence to Dr William J. Huang, Division of Urology, Depar tment of Surger y, Taipei VeteransGeneral Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C. netmail emailprotected - Received October 16, 2009 - Accepted Januar y 21, 2010194J Chin Med Assoc April 2010 Vol 73 No 4 2010 Elsevier Taiwan LLC and the Chinese Medical Association. tho rights reserved.development of varicocele in 6,200 boys aged 019 years.5 Delaney et al demonstrated that patients with varicocele are significantly taller and heavier than age- matched controls.6 Nielsen et al reported that varico- celes are less likely to be diagnosed among pear-shaped men.7The role of testosterone in the pathophys iology of varicocele is not established and testosterone might induce peacefulness of the humankind internal spermatic vein.8 Sheriff showed that there was increased choles- terol and glyceride in the testes of patients with bilateral varicocele compared with those in controls.9 Odabas et al suggested that the levels of lactic dehydrogenase (LDH) were higher in the spermatic vein than those in the off-base vein.10Other than findings on age, BMI and testosterone levels, there is expressage information about the correla- tion between biochemical markers and varicocele. Therefore, we conducted this prospective study to evaluate differences between patients with and with- out varicocele with regard to BMI, testosterone levels and serum biochemical markers including hemoglo- bin, alcalescent phosphatase (Alk-p), calcium, LDH, inor- ganic phosphate, -glutamine transpeptidase, uric acid, albumin, iron, cholesterol (Cho), triglyceride (TG), alanine aminotransferase, and aspartate aminot rans- ferase levels. We also wished to determine possible risk factors in the pathogenesis of varicocele.MethodsPatientsFrom January 2004 to June 2009, 102 patients with varicocele (Group A) were include for evaluation for this study. Ninety-five male patients who did not have varicocele were selected as controls (Group B). All of the 197 patients were normal, healthy young to middle-aged males. They were from the outpatient Department of Urology or had accepted a regular physi- cal check-up at the hospital. Varicocele was diagnosed by physical examination and confirmed by Doppler ultra- sonography. Varicocele grades were defined as grade 1, palpable only with the Valsalva transfer grade 2, palpable without the Valsalva maneuver and grade 3, visible from a distance.11 Patients with subclinical vari- cocele were excluded from the study. The range of ages was between 18 and 50 years old. BMI, and testos- terone, Alk-p, calcium, LDH, inorganic phosphate, glu- tamine transpeptidase, uric acid, albumin, iron, Cho, TG, alanine aminotransferase, aspartate aminotrans- ferase and hemoglobin levels were measured in all of the patients (normal ranges BMI testosterone, 241827 ng/dL Alk-p, one C280 U/L calcium, 8.110.7 mg/dL LDH, 95213 U/L inor- ganic phosphate, 2.14.7 mg/dL glutamine transpepti- dase, 860 U/L uric acid, 2.57.2 mg/dL albumin, 3.75.3 g/dL iron, 35200 g/dL Cho, 125240 mg/dL TG, 20200 mg/dL alanine aminotransferase, 040U/L aspartate aminotransferase, 545 U/L hemo- globin, 1216 g/dL). Patients with poor control of diabetes mellitus, hypertension or other systemic dis- ease or BMI 40 were excluded from the study.Patients were examined in a warm room while standing up and the scrotum was inspected and pal- pated. All the patients received Doppler ultrasonogra- phy of the scrotum. All the patients signed informed consent, and the study was O.K. by the Institu- tional Review Board of Taipei City Hospital.Statistical abstractThe Mann-Whitney U test and Krusk al-Wallis test were used for statistical analytic thinking, with p ResultsThe mean age was 35.4 years in group A and 36.5 years old in group B. Data for age, BMI, testosterone levels and biochemical markers for patients in both groups, and divergent grades of varicocele are shown in Tables 1 and 2. There were no significant differences in age between the patients of groups A and B and among the patients with diametrical grades of varicocele (grades 1, 2 and 3). Of the 102 patients in group A,19.6% were grade 1, 53.9% were grade 2 and 26.5% were grade 3. The BMI of patients with varicocele was significantly lower (p = 0.03) than that in patients without varicocele (Table 1). Patients with varicocele had lower serum levels of Cho, TG and testosterone and higher serum levels of LDH and Alk-p than patients without varicocele, but only Cho was significantly dif- ferent (p = 0.03, Table 1). There were no significant differences in the other biochemical markers between the patients of g roups A and B (Table 1).Patients with grade 3 varicocele had a lower BMI than patients with grades 1 and 2 varicocele, but this was not significantly varied (Table 2). Patients with grade 3 varicocele had lower serum levels of Cho and testosterone and higher serum levels of LDH and Alk-p than patients with low grade varicocele (grades 1 and2), but this was not significant. There were no signifi- cant differences in any of the other biochemical markers among the patients with grades 1, 2, and 3 varicocele (Table 2).Table 1. Age, serum biochemical markers, testosterone and BMI in groups A and B*A (n = 102) B (n = 95) p*Data presented as mean standard deviation statistical abridgment by Mann-Whitney U test. A = group A, with varicocele B = group B, without varicocele Alk-p = alkaline phosphatase LDH = lactic dehydrogenase IP = inorganic phosphate g-GT = g-glutamine transpeptidase superlative = alanine aminotransferase AST = aspartate aminotransferase BMI = body mass index.Table 2. Age, serum biochemical markers, testosterone and BMI according to different grades of varicocele*Grade 1 (n = 20) Grade 2 (n = 55) Grade 3 (n = 27) p*Data presented as mean standard deviation statistical analysis by Kruskal-Wallis test. Alk-p = alkaline phosphatase LDH = lactic dehydrogenase IP = inorganic phosphate g-GT = g-glutamine transpeptidase ALT = alanine aminotransferase AST = aspartate aminotransferase BMI = body mass index.DiscussionTsao et al showed that the prevalence and severity of varicoceles is inversely correlated with obesity, which indicates that obesity may result in a decreased nut- cracker yield.12 Handel et al reported that the preva- lence of varicocele decreases with increasing BMI,and the intellect for this is that increased adipose tissue decreases compression of the left renal vein and pre- vents detection due to adipose tissue in the spermatic cord.13 In the present study, patients with varicocele had a lower BMI than normal age-matched controls, but patients with grade 3 varicocele did not have a sig- nificantly lower BMI than patients with lower-gradevaricocele. The different etiology between our study and that of Tsao et al may be because patients in the previous study were young males serving in the army, which was different from our patients, but the etiol- ogy needs tho evaluation.We found that obese or overweight (BMI 25) patients might have higher serum levels of Cho and TG than normal subjects (BMI Kumanov et al demonstrated that gynecomastia is negatively correlated with BMI.15 abject serum follicle- stimulating hormone and high testosterone are good emblem factors for varicocelectomy.16 Ishikawa and Fujisawa showed that the vasodilatory effect of testosterone is decreased in high grade varicocele and they suggested that serum necessitous testosterone will be in- creased after varicocele repair.17 Ghosh and York have reported that testosterone levels are lower and Alk-p levels are higher in the testis of varicoce le-created rats.18In our study, patients with varicocele had lower serum levels of testosterone and higher serum levels of Alk-p than patients without varicocele. In addition, patients with grade 3 varicocele had lower serum levels of testosterone and higher serum levels of Alk-p than patients with low grade varicocele. Both parameters did not crap statistical significance, and the reason might be due to a whacking standard deviation for testo- sterone and Alk-p levels. Therefore, the role of testo- sterone and Alk-p in patients with varicocele needs kick upstairs evaluation however, we did not measure folli- cle-stimulating hormone in this study. Our previous study showed that more free radicals might be gener- ated in varicocele veins than in the corresponding peripheral veins in patients with varicocele, because8-hydroxy-2 -deoxyguanosine levels of leukocyte DNA in spermatic veins are higher than in the correspond- ing peripheral veins in these patients.19 Yesilli et al showed that LDH and malondialdehyde levels are greater in the sperm of infertile men with varicocele,but the levels of LDH and malondialdehyde does not decrease after varicocelectomy.20 In the present study, serum levels of LDH were higher in patients with varic- ocele than in patients without varicocele. Further- more, higher serum levels of LDH were found in patients with high-grade varicocele than in patients with lower-grade varicocele. Neither of these findings was statistically significant. Therefore, the effect of LDH in patients with varicocele needs further evaluation.Our findings suggest that an increase in body generative might be associated with relieving the nutcracker phe- nomenon of the superior mesenteric arteria to the left renal vein. However, this study had some limitations. First, we did not compare the veer in severity of varicocele in the same individual as BMI changed over time. Second, we did not use other imaging studies, such as computed imagination or magnet ic resonance imaging, to demonstrate the relationship between vis- ceral fat and the region of the superior mesenteric artery, left renal vein and aorta. Third, the representative numbers were small from an epidemiological view, because all of the subjects needed to have selective information for biochemical mark- ers, which restricted the patient numbers. Therefore, we need to include more cases in future studies.In conclusion, patients with varicocele might have significantly lower serum levels of cholesterol than patients without varicocele. In addition, our findings support the hypothesis that patients with a greater BMI may have advantages in relieving the nutcracker phe- nomenon causing significant varicoceles, but further studies are required to clarify this issue.References1. Jarrow JP. Effects of varicocele on male infertility. bombinate ReprodUpdate 200175964.2. Witt MA, Lipshultz LI. Varicocele a progressive or passive lesion?Urology 1993425413.3. Gorelick JI, Goldstei n M. Loss of fertility in men with varicocele.Fertil Steril 1993596136.4. Levinger U, Gornish M, Gat Y, Bachar GN. Is varicocele preva- lence increasing with age? Andrologia 2007397780.5. Kumanov P, Robeva RN, Tomova A. Adolescent varicocelewho is at risk? Pediatrics 2008121537.6. Delaney DP, Carr MC, Kolon TF, Snyder HM, Zderic SA. 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