Effects of percutaneous varicocele repair on testicular volume:results from a 12-month follow-up

Varicocele is a comm on fin ding in men. Varicocele correcti on has bee n advocated for young patients with testicular hypotrophy, but there is a lack of morphofunctional follow-up data. We assessed whether percutaneous treatment of left varicocele is associated with testicular "catch-up growth" in the following 12 months by retrospectively reviewing data from an electronic database of 10 656 patients followed up in our clinic between 2006 and 2016. We selected all young adults (<35 years) with left varicocele who un derwe nt percuta neous treatment, had a minimum of 12 mon ths' ultraso und imagi ng follow-up, and had no other con ditions affecting testicular volume. One hundred and fourteen men (mean±standard deviation [s.d.] of age: 22.8 ± 5.4 years) met the inclusion and exclusion criteria. Left testicular hypotrophy (LTH), defined as a >20% difference between left and right testicular volume at baseline, was observed in 26 (22.8%) men. Participants with LTH (mean±s.d.: 14.5 ± 2.7 ml) had lower baseline testicular volume compared to those without LTH (mean±s.d.: 15.7 ± 3.8 ml;P= 0.032). Repeated measures mixed models showed a sign ifica nt in teraction betwee n LTH and time posttreatme nt when correcting for baseli ne left testicular volume (β= 0.114, 95% confidence interval [Cl]: 0.018-0.210, P=0.020), resulting in a catch-up growth of up to 1.37 ml per year (95% Cl: 0.221- 2.516). Age at intervention was also associated with reduced testicular volume (-0.072 ml per year, 95% Cl:-0.135--0.009;P = 0.024). Percutaneous treatment of left varicocele in young adults with LTH can result in catch-up growth over 1 year of follow-up. The reproductive and psychological implicati ons of these findings n eed to be confirmed in Ion ger and larger prospective studies.

Safety and efficacy of DEM-TACE performed with drug-eluting microspheres smaller than 300μm in patients with HCC and TIPS

Aim:Safety and efficacy evidence of drug-eluting-microspheres trans-arterial chemoembolization(DEM-TACE)in patients with hepatocellular carcinoma(HCC)and trans-jugular intrahepatic portosystemic shunt(TIPS)is lacking.The aim of this retrospective study was to report the safety and efficacy of DEM-TACE procedures performed with microspheres smaller than 300μm in patients with HCC and TIPS in a high-volume transplant center.Methods:Embolization was standardized by initiating DEM-TACE with microspheres smaller than 100μm,and if stasis was not achieved,adjunctive embolization with 100-300 or 200μm microspheres was administered.With regards to efficacy,the oncological response was evaluated and categorized according to mRECIST criteria at 1,3-6,9-12,and 15-18 months.Reporting the safety profile,detailed laboratory analysis was performed before,at 36-48 h,and 30-60 days after the procedure.Adverse events(AEs)were recorded;post-embolic syndrome was defined as the onset of fever/nausea/pain after the procedure.Late onset hepatobiliary complications were evaluated by follow-up imaging with computed tomography or magnetic resonance(CT/MR).Results:From December 2007 to November 2020,17 HCC patients(25 HCC nodules)with patent TIPS underwent 20 DEM-TACE.Embolization was performed only with microspheres smaller than 100μm in 3/20 DEM-TACE(15%);adjunctive embolization with 100-300 or 200μm microspheres was required in 17/20 DEMTACE(85%).Reported early AEs were post-embolic syndrome(9/20;45%)all of grade 1-2,late AEs were asymptomatic acute liver bile duct injury(2/20;10%),and in one case we observed hepatic abscess(1/20;5%)resulting in death due to sepsis.With regards to efficacy,the oncological response was evaluated and categorized according to mRECIST criteria.Complete response(CR)at 1,3-6,9-12,and 15-18 months was 52%,50%,50%,and 50%,respectively.Objective response(CR+partial response)at 1,3-6,9-12,and 15-18 months was 95%,71%,70%,and 50%,respectively.Conclusion:DEM-TACE with drug-eluting-microspheres smaller than 300μm can be performed in appropriately selected patients with TIPS.