Effects of Varicocelectomy on Abnormal Semen Parameters in Patients with Clinically Palpable Varicocele (original) (raw)
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Objectives:-To evaluate the efficacy of varicocelectomy in patients with clinical versus subclinical varicocole as regards the seminal parameters.Patients and Methods:-A total of 162 patients with varicocele (72 subclinical and 90 clinical) were included in the study. Semen analysis was done for all patients before and after 3 to 6 months of varicocelectomy. Improvements of semenial parameters were statistically significant in patients with clinical varicocele (P< 0.05). Bilateral and right side varicocele were more common in patients with subclinical varicocele. Also there incidence secondary infertility higher patients presented with subclinical varicocele compared with patients presented with clinical varicocler (P< 0.05).As regard, the effects of varicocelectomy in patients with subclinical varicocele and the clinical differences between these patients and patients with clinical varicocle, we recommend avoiding varicocelectomy in this group of patients unless no identifiab...
Improvement in semen parameters after varicocoelectomy
International Surgery Journal, 2020
Background: Varicoceles are associated with abnormal sperm parameters. The difference is more marked in cases with infertility and higher grades of varicocele. Following ligation of varicocele, there is a significant improvement in the sperm counts.Methods: The study was conducted in the department of general surgery at Maulana Azad Medical College and associated Lok Nayak Hospital from September 2012 to April 2014. The study was conducted on 40 numbers of patients. These were divided into 2 groups, group 1 (n=20) constituted of patients with varicocele who are symptomatic. Group 2 (n=20) constituted of patients with varicocele who are asymptomatic (infertile). All patients were evaluated by clinical examination and Doppler to grade the varicocele. All patients underwent detailed semen analysis. Patients of both the groups underwent FNAC of bilateral testes. The patients with clinical or Doppler detectable varicocele were taken up for low ligation of varicocele. Patients were follow...
Efficacy of Varicocelectomy in Improving Semen Parameters: New Meta-analytical Approach
Urology, 2007
OBJECTIVES To determine the efficacy of varicocelectomy in improving semen parameters. METHODS A meta-analysis was performed to evaluate both randomized controlled trials and observational studies using a new scoring system. This scoring system was developed to adjust and quantify for various potential sources of bias, including selection bias, follow-up bias, confounding bias, information or detection bias, and other types of bias, such as misclassification. Of 136 studies identified through the electronic and hand search of references, only 17 studies met our inclusion criteria. The study population was infertile men with clinically palpable unilateral or bilateral varicocele and at least one abnormal semen parameter who had undergone surgical varicocelectomy (high ligation or inguinal microsurgery). Only those studies that had at least three semen analyses (ie, sperm count, motility, and morphology) per patient, before and after surgical varicocelectomy, were included. RESULTS The combined analysis demonstrated that the sperm concentration increased by 9.71 ϫ 10 6 /mL (95% confidence interval [CI] 7.34 to 12.08, P Ͻ0.00001) and motility increased by 9.92% (95% CI 4.90 to 14.95, P ϭ 0.0001) after microsurgical varicocelectomy. Similarly, the sperm concentration increased by 12.03 ϫ 10 6 /mL (95% CI 5.71 to 18.35, P ϭ 0.0002) and motility increased by 11.72% (95% CI 4.33 to 19.12, P ϭ 0.002) after high ligation varicocelectomy. The improvement in World Health Organization sperm morphology was 3.16% (95% CI 0.72 to 5.60, P ϭ 0.01) after both microsurgery and high ligation varicocelectomy. CONCLUSIONS Surgical varicocelectomy significantly improves semen parameters in infertile men with palpable varicocele and abnormal semen parameters.
Association between varicocele grade and semen analysis parameter
Medical Journal of Indonesia
Background: Varicocele is a condition characterized by elongation, dilatation and tortuousity of spermatic vein in pampiniform plexus. Approximately 50% of infertility cases among men are caused by varicocele. The varicocele may affect the components of sperm. This study aimed to determine the association between varicocele grade based on ultrasound Doppler examination and sperm concentration, sperm motility, and sperm morphology based on semen analysis examination.Methods: This was a descriptive, cross-sectional study which used secondary data from 85 patients that visited Department of Urology, Cipto Mangunkusumo Hospital, then underwent ultrasonography examination at Department of Radiology, Cipto Mangunkusumo Hospital and semen analysis examination at Department of Obstetrics and Gynecology, Cipto Mangunkusumo General Hospital.Results: Varicocele grade was significantly associated with sperm morphology, concentration and motility (all p<0.05). Significant association was foun...
Time for Improvement in Semen Parameters After Varicocelectomy
The Journal of Urology, 2012
While there are a number of studies documenting a positive effect of varicocelectomy on semen parameters, the length of time required following varicocelectomy for semen quality to improve is not well established. Therefore, in this study we identified the changes with time in semen parameters after varicocelectomy. Materials and Methods: The records and database of 304 patients who underwent varicocele repair for subfertility were reviewed retrospectively. All men had at least 2 preoperative semen analyses as well as semen testing at 3 and 6 months postoperatively. Results: For the 100 patients who met the study inclusion criteria mean sperm counts increased significantly by 3 and 6 months after varicocelectomy (by 53% and 38% by 3 and 6 months, p ϭ 0.0003 and 0.001, respectively). By 3 and 6 months the combined groups had a mean 2.5 and 1.5-fold higher total motile count compared to the preoperative total motile count, respectively. There was no further improvement in semen parameters in those men followed for more than 6 months. There were no statistically significant differences in the improvement in semen volume, motility, count or total motile count comparing the results at 3, 6 and more than 9 months postoperatively. Conclusions: Sperm parameters improve by 3 months after varicocele repair and then do not improve further. This finding should allow physicians to decide quickly if varicocelectomy has been effective and, then, if required, plan on the use of other therapies to manage the couples' infertility.
BioMed Research International
Varicocele, a vascular event, is associated with infertility due to testicular damage that causes abnormal spermatogenesis in males. The goal of this study is to ascertain the diagnostic significance of scrotal color Doppler ultrasonography (CDUS) by measuring peak systolic value (PSV) and resistive index (RI) of the arteries supplying blood to the testis and their association with semen quality attributes. Sixty prospective patients (age: 20-50 years) undergoing microsurgical varicocelectomy at a teaching hospital were included in the study. Semen parameters and CDUS were recorded and testicular blood flow was determined as PSV and RI of subcapsular artery and intraparenchymal artery of the testes. Nonparametric statistics was applied to test the correlation/association of the semen quality with the PSV, RI, and other variables. Results revealed a significant negative correlation (r = -0.28; p < 0.05) between progressive motility of spermatozoa and resistive index of the intrapa...
Journal of Evolution of Medical and Dental Sciences, 2020
BACKGROUND Varicocele is the dilatation of pampiniform plexuses which can cause infertility. Incidence of varicocele is around 15-80 % and remains the most common treatable cause of infertility in men. The aim of this study was to identify the preferred method of varicocelectomy in patients with infertility, which gives optimal improvement in semen parameters. This study compares laparoscopic varicocelectomy and subinguinal varicocelectomy. METHODS This is a prospective interventional study carried out in the Department of Urology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai from August 2017 to July 2019. We included patients with documented infertility with clinical varicocele. Only couples with no other attributable causes including female factors for infertility were included. Patients with previous history of surgery for inguinal hernia, testicular pathology were excluded from the study. We included 25 patients who satisfied the inclusion criteria. They were subjected to physical examination, doppler study and semen analysis. The patients were randomised into 2 groups, A & B by random allocation. Group A (12 patients) underwent laparoscopic varicocelectomy and group B (13 patients) underwent subinguinal varicocelectomy. All patients were regularly followed up at 3 months and 6 months period postsurgery. RESULTS Review at immediate post-operative period, follow ups at 3 & 6 months were undertaken. History of conception, clinical examination, semen analysis according to WHO 2010 manual and doppler studies by Sarchetsi scale were performed. Three factors in seminal parameters namely sperm concentration, motility & morphology were assessed. Varicocele recurrence was also assessed. There had been a statistically significant improvement in semen parameters in all the patients who underwent varicocelectomy (p value p< 0.005). On comparing the laparoscopic and sub-inguinal surgical techniques, there was no significant variation in increase in sperm concentration, sperm motility and morphology. CONCLUSIONS Varicocelectomy improves the semen parameters. No significant variation was observed when the different surgical approaches of varicocelectomy were compared.
Human Andrology, 2012
To evaluate the preoperative semen, laboratory, and clinical parameters that predict the improvements in semen quality after a varicocelectomy. Materials and methods This retrospectively study evaluated 130 infertile male patients aged 21-45 years (median: 32 years) with a left varicocele treated by a varicocelectomy from December 2008 to March 2012. The parameters evaluated included varicocele grade, age, testicular size, serum testosterone, luteinizing hormone, follicle-stimulating hormone (FSH), preoperative sperm density, and sperm motility. Subinguinal microsurgical varicocelectomy was the operative technique used. Semen analysis was carried out within 1 month preoperatively and reexamined 12 months after the varicocelectomy. Data were collected from files 1 year postoperatively. A logistic regression analysis was carried out to identify the parameters associated with improvements in semen quality. Results Sixty-seven of 130 patients (51.5%) showed an improvement in the semen concentration, and this improvement was statistically significant with grade 2 and grade 3 varicoceles, low FSH, and high sperm concentration preoperatively. Seventyone of 130 patients (54.6%) showed an improvement in sperm motility, and this improvement was statistically significant in sperm motility preoperatively. In the univariate analysis and multivariate analysis for improved group grade 2, 3 varicoceles, low FSH preoperatively, high sperm motility, and high sperm concentration preoperatively were good predictors for sperm concentration postoperatively. Univariate analysis indicated that the predictor for an improvement in sperm motility was a high sperm motility rate preoperatively. Multivariate analysis of sperm motility indicated that there was a statistically significant improvement in the sperm concentration and the sperm motility rate (Po0.032 and Po0.022), respectively, if FSH was less than 10 mIU/ml. Conclusion Varicocelectomy improves both sperm concentration and motility. Our results indicate that infertile male patients with grade 2 and grade 3 varicoceles, a low serum FSH level, high sperm motility, and sperm concentration have a good chance of experiencing an improvement in the sperm concentration after a varicocelectomy.
The Journal of Urology, 1997
Purpose: We studied the effect of varicocelectomy on Kruger morphology and semen parameters. Materials and Methods: A total of 33 subfertile men diagnosed with varicoceles was evaluated 3 months before, and 3 to 4 and 6 to 8 months after varicocelectomy. Evaluation involved routine semen analysis and sperm morphology using K-ruger classification. Results: Significant improvement in sperm concentration and count was found after varicocelectomy (sperm count preoperatively 117.1 2 29, 3 to 4 months postoperatively 162.5-+ 41 and 6 to 8 months postoperatively 139.8 2 25 million sperm, p = 0.0095). Using Kruger classification, evaluation of sperm morphology revealed overall significant increase in percentage of normal A forms at 3 to 4 and 6 to 8 months after surgery (from 9.8 5 5.8 % A forms, 13.6 t-7.7 % A forms, and 14.5 2 7.5 % A forms, respectively, p = 0.0002, normal greater than 14%). Twelve of the 26 patients (46%) with abnormal sperm morphology preoperatively and greater than 4% A forms reached normal levels 3 months postoperatively. Six months after surgery only 6 patients maintained normal values and 3 of the initial 14 nonresponders became normal (9 of 26, 36%). Three patients with severe teratozoospermia (less than 4% A forms) showed improvement in sperm morphology. Four patients with normal sperm morphology preoperatively were not affected by varicoceledomy. Conclusions: Surgical correction of varicocele was associated with significant improvement in sperm morphology evaluated using Kruger classification. Concentration and count improved aRer varicocelectomy. Changes were observed as early as 3 months aRer surgery.