Relationship between the number of veins ligated in a varicocelectomy with testicular volume, hormonal levels and semen parameters outcome

Pasqualotto, Fábio Firmbach; Lucon, Antônio Marmo; Góes, Patrícia Freitas; Sobreiro, Bernardo Passos; Hallak, Jaime Eduardo Cecílio; Pasqualotto, Eleonora Bedin; Arap, Sami

doi:10.1007/s10815-005-5147-4

Cited by 27 publications

(18 citation statements)

References 25 publications

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“…Recent studies have shown that the total number of veins ligated has a statistically significant positive correlation with improvements in total sperm motility and sperm concentration (18,19). These results suggest that ligating a larger number of veins should lead to a greater decrease in the reflux, which in turn would lead to diminished insult to spermatogenesis.…”

Section: Discussionmentioning

confidence: 98%

The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply

Cocuzza

Pagani

Coelho

et al. 2010

Fertility and Sterility

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Section: Discussionmentioning

confidence: 98%

The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply

Cocuzza

Pagani

Coelho

et al. 2010

Fertility and Sterility

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“…Pasqualotto et al. [25] reported that postoperative serum TT increases were limited to patients who had more than 10 veins ligated during varicocelectomy. The clinical grade and the vein diameter might not be the determining factors for how varicocele affects testicular functions.…”

Section: Discussionmentioning

confidence: 99%

Impact of Varicocelectomy on Gonadal and Erectile Functions in Men with Hypogonadism and Infertility

Zohdy

Ghazi

Arafa

2011

The Journal of Sexual Medicine

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Introduction Previous reports linked varicocele in infertile males with Leydig cell dysfunction and hypogonadism. Aim The aim of this study was to determine the impact of varicocelectomy on serum total testosterone (TT) level and erectile function in men with infertility and clinical varicocele. Methods This study included 141 heterosexual infertile men diagnosed to have clinical varicocele. They were divided into two groups: group 1 (103 men), who had microsurgical varicocelectomy, and group 2 (38 patients), who decided to pursue assisted reproduction procedures. All participants completed the International Index of Erectile Function (IIEF)-5 questionnaire and underwent semen analysis. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and TT were measured both at recruitment time and 6 months later. Main Outcome Measure Changes in serum TT and IIEF-5 following varicocelectomy. Results In group 1, the mean TT level increased significantly post-varicocelectomy (379.1 ± 205.8 to 450.1 ± 170.2 ng/dL, P < 0.0001). No similar change was found in group 2. Out of the 49 patients in group 1 with hypogonadism at baseline assessment (TT < 300 ng/dL), 37 (75.5%) exhibited a postoperative normalization of TT. However, only 3/15 hypogonadal men (20%) in group 2 had normal testosterone levels at the second visit. IIEF-5 scores improved significantly postoperatively in patients with hypogonadism (17.1 ± 2.6 to 19.7 ± 1.8, P < 0.001). Neither operating vein diameter 3.6 ± 0.57 mm nor testicular size 10.46 ± 3.3 mL correlated with the mean change in TT (71.1 ± 101.2 ng/dL) (r = 0.162, P = 0.183 and r = −0.077, P = 0.536, respectively). Conclusions Varicocele is associated with hypogonadism in some infertile patients. Varicocelectomy significantly improves serum testosterone in infertile men, especially those with hypogonadism. This improvement in TT level may be reflected in the IIEF score.

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“…Shindel et al [27] suggested that the number of ligated veins is positively correlated with an increase in sperm motility. Pasqualotto et al [28] reported that patients with more than 10 ligated veins at the time of varicocelectomy have better chances of showing an improvement in sperm concentration. In the present study, the presence of more than 9 ligated veins was a good prognostic factor for successful varicocelectomy.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Successful Varicocelectomy in Infertile Patients

Chen¹,

Chen

2011

Urol Int

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Aim: To examine the predictive factors of successful varicocelectomy in infertile patients. Methods: Thirty-five infertile male patients with varicocele and requiring varicocelectomy were recruited in this study. The patients were divided into 2 groups based on their recovery outcome after subinguinal microsurgical varicocelectomy. Patients who showed significant improvement on their sperm density, motility and morphology 6 months after varicocelectomy were designated as group 1, whereas those who showed no improvement 6 months after surgery were designated as group 2. The predictive factors that were examined included: age; preoperative semen quality (i.e. sperm density, motility and morphology); testicular volume; seminal volume; varicocele grade; the number of ligated veins; body mass index (BMI), and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone, alkaline phosphatase (Alk-p), lactic dehydrogenase (LDH), cholesterol and triglyceride. Results: Sperm density, motility and morphology improved significantly 6 months after varicocelectomy in group 1 patients (n = 35; 71.4%). Group 1 patients had significantly higher testicular volumes (mean ± SD: 29.6 ± 5.9 vs. 23.2 ± 6.1 ml), lower FSH (11.3 ± 2.9 vs. 16.1 ± 4.8 mIU/ml) and higher numbers of ligated veins (9.3 ± 0.8 vs. 7.9 ± 0.7) than group 2 patients. No significant association was observed between surgical outcome and age, preoperative sperm density, motility and morphology, seminal volume, varicocele grade, BMI and serum levels of LH, prolactin, testosterone, Alk-p, LDH, cholesterol and triglyceride. Conclusions: These findings suggest that the significant predictive factors of successful varicocelectomy in infertile patients were high testicular volume (>29.6 ml), low serum concentration of FSH (<11.3 mIU/ml) and high number of ligated veins (>9).

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Relationship between the number of veins ligated in a varicocelectomy with testicular volume, hormonal levels and semen parameters outcome

Cited by 27 publications

References 25 publications

The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply

The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply

Impact of Varicocelectomy on Gonadal and Erectile Functions in Men with Hypogonadism and Infertility

Predictive Factors of Successful Varicocelectomy in Infertile Patients

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