Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: which subfertile patients benefit from surgery?

Abstract

Background:The exact mechanism of varicocele-related infertility is still elusive, therefore, the current challenges for its management lie in determining which patients stand to benefit most from surgical correction. The authors aimed to assess the clinical factors affecting semen improvement after left microsurgical subinguinal varicocelectomy (MSV) in relation to patient age, ultrasound varicocele grading (USVG), and presence of a right subclinical varicocele (RSV).Methods:From 2010 to 2017 a total of 228 infertile patients underwent left MSV for clinical varicocele. Descriptive statistics were used to describe the cohort and verify the surgical benefit in terms of semen improvement, in addition, subsets of patients were selected according to clinical covariates. Logistic regression modeling was applied to evaluate the presence of RSV, operative time, age, and USVG as explanatory variables.Results:Sperm concentration (SC), progressive sperm motility (PSM), and normal sperm morphology (NSM) increased significantly after surgery (p = 0.002; p = 0.011; p = 0.024; respectively). Mean SC improved after MSV in ⩾35 year-old patients and the grade 3 USVG group (p = 0.01; p = 0.02; respectively). Logistic regression modeling showed a that the probability of SC improvement was 76% lower in subjects presenting RSV (p = 0.011). In addition, patients with a grade 3 USVG presented a three-times greater probability of SC improvement compared with patients with a lower USVG (p = 0.035). In addition, older patients showed a greater probability of SC improvement after MSV (p = 0.041).Conclusions:MSV is an effective varicocele-related infertility treatment that should also be offered to older patients. In addition, patients with a higher USVG benefit from surgery. In infertile men with an RSV in association with a left clinical disease, a bilateral varicocele repair should be considered.

Can preoperative gonadotropin and testosterone levels predict the success of varicocelectomy?

“…Conversely, Palmisano et al. (2019) reported mean sperm concentration improved after varicocelectomy in ⩾35‐year‐old patients. Since our patient group was in a narrow age range, we found that age does not affect post‐operative sperm parameters.…”

“…Palmisano et al. (2019), in their study with 228 patients who underwent varicocelectomy, found that patients with a grade 3 ultrasound varicocele grading (USVG) presented a three times greater probability of sperm concentration improvement compared with patients with a lower USVG. Infertile patients with high‐grade varicocele benefit more from intervention; still, a higher grade is more often associated with testicular atrophy, resulting in a loss of potential sperm recovery.…”

Clinical outcome of pediatric and young adult subclinical varicoceles

“…In comparison, indications prompting repair of left-sided clinical varicoceles in adolescents have varied, but have included persistent testicular size discrepancy, abnormal semen parameters, and testicular discomfort or pain. 13 14 15 Varicocele repair during the adolescent period represents a preemptive attempt to enhance peripubertal testicular growth and potentially function in the hope of improving future fertility potential.…”

Combined treatment of oligoasthenospermia by postoperative Speroton therapy in patients with varicocele

“…Частота рецидивов варикоцеле после флебэктомии с применением пахового доступа достигала, по данным EAU, 13,3 %. В то же время микрохирургическая эктомия ВРВ семенного канатика через субингвинальный доступ характеризуется наименьшей частотой осложнений (0,8-4,0 %) и считается сейчас «золотым стандартом» в лечении варикоцеле, в том числе при наличии клинических показаний к те рапии мужского бесплодия, обусловленного патозоо спермией [2][3][4][5][6].…”

“…По данным С. И. Гамидова и соавт., консервативная монотерапия варикоцеле минерально-витаминными комплексами улучшала параметры спермы на 30 % [6]. По мнению же многих исследователей, наиболее эф-фективно (на 70 %) улучшает параметры спермы при варикоцеле микрохирургическая эктомия ВРВ семенного канатика [3][4][5]. Однако хирургическая коррекция варикоцеле в случае нарушения сперматогенеза не всегда способствует восстановлению мужской фертиль ности, в связи с чем актуальным становится вопрос об эффективности комбинированного лечения патозооспермии, включающего флебэктомию и консервативную терапию в послеоперационном периоде с целью улучшения морфофункциональных показателей сперматозоидов.…”