Predictive factors of successful redo varicocelectomy in infertile patients with recurrent varicocele

Abstract

To examine the predictive factors of successful redo varicocelectomy in infertile patients with recurrent varicocele, we made a retrospective study. Twenty-one patients who had improved quality of spermatozoon 6 months after RV were designated as group 1, those with no improvement as group 2 (17 subjects) and those who received close surveillance as group 3 (10 patients) were recruited. The predictive factors included were time to recurrent varicocele; semen quality; testicular volume; number of ligated veins; body mass index; serum levels of follicle-stimulating hormone (FSH), luteinising hormone and testosterone; scrotal temperature; and peak retrograde flow (PRF) and maximal vein diameter (MVD) by colour Doppler ultrasound. The quality of spermatozoon improved significantly 6 months after RV in group 1 patients (21, 55.3%), and no improvement in group 2 and 3 patients. Patients in group 1 also had significantly lower FSH and PRF, longer time to recurrent varicocele, higher number of ligated veins and larger testicular volume than the group 2 (17, 44.7%) and group 3 patients. The significant predictive factors of successful RV were lower FSH and PRF; longer time to recurrent varicocele; and larger testicular volume preoperatively and a higher number of ligated veins during redo varicocelectomy.

Systematic review of treatment methods for recurrent varicoceles to compare post‐treatment sperm parameters, pregnancy and complication rates

“…The outcome measures were spontaneous pregnancy, improvement in sperm parameters and complications (recurrence, hydrocele, testicular atrophy and infection–haematoma). As shown in Table , of the studies reporting treatment of recurrent varicocele, 21 (612 subjects) met the inclusion criterion, reporting at least one of the post‐treatment sperm parameters, spontaneous pregnancy and complication rates in adults and adolescents who underwent treatment for recurrent varicocele (Çayan & Akbay, ; Chawla et al, ; Chen, ; Çift & Yucel, ; Feneley et al, ; Flati et al, ; Glassberg et al, ; Grober et al, ; Guevara et al, ; Jargiello et al, ; Kaufman et al, ; Kenawi, ; Kim et al, ; Lund & Jensen, ; Madjar et al, ; Mazzoni et al, ; Moon et al, ; Niedzielski et al, ; Punekar et al, ; Sze et al, ; Yan et al, ). Interventions were divided into surgical (open or laparoscopic) and radiological (sclerotherapy or embolisation) groups.…”

“…Recurrent varicoceles can be treated via open redo surgical, radiologic and laparoscopic approaches (Çayan & Akbay, ; Chawla, Kulkarni, Kamal, & Zini, ; Chen, ; Çift & Yucel, ; Feneley, Pal, Nockler, & Hendry, ; Flati et al, ; Glassberg et al, ; Grober, Chan, Zini, & Goldstein, ; Guevara, El‐Hilal, & Darcy, ; Jargiello et al, ; Kaufman et al, ; Kenawi, ; Kim et al, ; Lund & Jensen, ; Madjar, Moskovitz, Issaq, Weinberger, & Nativ, ; Mazzoni, Minucci, & Gentile, ; Moon, Cho, Kim, Park, & Park, ; Niedzielski & Paduch, ; Punekar, Prem, Ridhorkar, Deshmukh, & Kelkar, ; Sze et al, ; Yan, Wu, & Wang, ). Recurrent varicoceles have been previously treated with radiological methods, because of redo surgical complications, including testicular atrophy, hydrocele and nerve injury (Feneley et al, ; Guevara et al, ; Jargiello et al, ; Kaufman et al, ; Kim et al, ; Mazzoni et al, ; Punekar et al, ; Sze et al, ).…”

Treatment effect of TUSPLV on recurrent varicocele

“…v) Ligation position is extremely low. Results obtained from a prior study showed (12,13) that in cases that testicular vein is positioned lower, more branches of the vein are presented. Testicular vein branches below the height of L 5 are usually 1–5.…”

Microsurgical subinguinal varicocelectomy in patients with recurrent or persistent varicocele

“…Overlooking small internal spermatic veins, especially during macroscopic surgery which later become dilated, are the disadvantages of macroscopic surgery [11] , it is still controversial which treatment is to be preferred for recurrent varicocele. Although microsurgery, embolization, and laparoscopic surgical methods are preferable methods for varicocele recurrence, varicocelectomy with microsurgical method is the recommended treatment modality due to its lesser number of side effects and complications [12][13][14][15][16] .…”

“…In a retrospective study of 48 infertile patients with varicocele recurrence, in which the predictive factors of success after recurrence were investigated, patients were divided into three groups as those with (n=17) and without (n=10) improvement in their semen parameters, and patients who did not prefer surgery (n=21), and as a predictive factors of success, low FSH level, low retrograde peak flow, number of ligated veins, and late recurrence period were determined [15] .…”