Predictive factors associated with successful varicocele repair a study of 139 infertile men with valicocele

PURPOSE: To determine pretreatment parameters which predict improvements following varicocele repaire in semen quality. MATERIALS AND METHODS: We retrospectively evaluated a total of 139 infertile patients who underwent varicocelectomy from February 1995 to March 2000. A logistic regression analysis was performed to identify parameters associated with improvements in semen quality. Parameters evaluated included varicocele grade, age, testicular volume, serum testosterone, liteinizing hormone (LH), follicle-stimulating hormone (FSH), preoperative sperm density and sperm motility. RESULTS: Of 139 patients 71 (51.0%) improved sperm concentration and 59 (42.4%) improved sperm motility postoperatively. Overall, median sperm density significantly increased from 10 x 10(6)/ml preoperatively to 30 x 10(6)/ml postoperatively. Sperm motility also significantly increased 33% to 45%. In logistic regression analysis, varicocele grade (odds ratio [OR] = 5.7; 95% confidential interval [CI : 1.9-17), FSH level ([OR] = 0.76; [CI]: 0.60-0.96) and sperm motility ([OR] = 1.03; [CI]: 1.0-1.1) were independent predictive factors for improvement in sperm concentration. CONCLUSION: Varicocelectomy improves sperm concentration and motility. Our data suggest that patients with grade 3 varicocele, low serum FSH level and high sperm motility are more likely to benefit from varicocele repair in sperm concentration.     

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

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.     

Predictors of improved seminal parameters and fertility after varicocele repair in young adults

The aim of our study was to determine hormonal or biochemical markers in patients with clinically palpable left varicocele but without a history of infertility, with especial emphasis on nitric oxide, related with improved seminal parameters after varicocelectomy. Semen samples were obtained from 202 patients with left varicocele grade II or III. Nitric oxide levels in seminal plasma were determined by the Griess technique. Testicular volume was determined ultrasonographically in both testes and hormonal profile was measured. The post-operative sperm concentration increased significantly in patients with normal sperm count or moderate oligozoospermia, but we did not find an increment in sperm count in patients with mild and severe oligozoospermia after surgery . The mean percentage of normal motility significantly increased after surgery, but we did not observe a significant increment in morphologically normal sperm count and testicular volume after varicocele repair. Moreover, we did not find any correlation between nitric oxide concentrations and severity of oligozoospermia, asthenozoospermia or abnormal sperm morphology in this population. It is concluded that in the general male population, varicocele repair is not associated with an improved semen profile in all cases. We did not observe a significant correlation between nitric oxide concentrations and semen profile.     

Preserved testicular artery at varicocele repair

Whether or not varicocele causes infertility is a contentiously debated issue. This study aimed to compare semen parameters and pregnancy rate in infertile males who underwent varicocelectomy with preserved or accidentally ligated testicular artery. Ninety-five infertile oligoasthenozoospermic patients with left-sided varicocele were subjected to subinguinal varicocelectomy with trial of preserving testicular artery. According to absence or presence of testicular artery in the histological excised pedicle the cases were divided into two groups; group 1 ( n  = 60) with preserved testicular artery and group 2 ( n  = 35) where the artery was accidentally ligated being not defined or injured. Semen analysis was carried out after 4, 8 and 12 months and post-operative pregnancy rate was assessed after 1 year. Serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone (T) were estimated pre- and post-operatively. Semen parameters (total sperm count, sperm concentration and sperm motility) showed significant increase post-operatively compared with pre-operative parameters but were comparable in both groups with no significant difference. Serum FSH, LH, T hormones and pregnancy rate (23.3% versus 22.9%) 1 year post-operatively showed no significant difference. It is concluded that accidental ligation of testicular artery has no deleterious effect on semen parameters during primary varicocele repair if the testicular arterial supply was not compromised.     

Preoperative parameters related to the improvement of semen characteristics after surgical repair of varicocele in subfertile men

To know the parameter related to improvement of each semen characteristic (sperm density and percentage of progressive motile sperm) after high ligation of the left internal spermatic vein, 119 men from infertile couples were investigated. In each individual, the semen characteristic was considered to be different from the postoperative mean value if it was over or below 2 SD of the preoperative mean. Although no relationship was detected with the age of the patient, the duration of infertility or the preoperative semen characteristics, a definite relationship was found between the degree of varicocele and the improvement in each semen characteristic. For improvement of the sperm density, each of the volume and the score count by Johnsen's scale of the affected and unaffected testes and the serum hormone values (LH, FSH and testosterone) showed correlations. Meanwhile, for the improvement of the percentage of progressive motile sperm, correlations were found only with each of the testicular volume on the unaffected side and the serum testosterone level.     

Age is a significant predictor of early and late improvement in semen parameters after microsurgical varicocele repair

Accumulating evidence indicates that varicocele repair improves sperm quality. However, longitudinal changes in sperm parameters and predictors of improved semen characteristics after surgery have not been fully investigated. We retrospectively reviewed data from 100 men who underwent microsurgical subinguinal varicocele repair at a single centre. Follow‐up semen examinations were carried out at 3, 6 and 12 months post‐operatively. Logistic regression was used to identify predictors of early (3 months) and late (≥6 months) improvement in semen parameters after varicocele repair. At 3 months post‐operatively, 76.1% of the patients had improved total motile sperm counts, which continued to improve significantly up to 12 months post‐operatively (p = .016). When comparing changes in semen parameters between younger (<37 years) and older (≥37 years) men, post‐operative improvements in sperm concentration and motility were greater among younger men. Multivariate analysis showed that younger age was associated with early (p = .043) and late (p = .010) post‐operative improvement in total motile sperm count. Our findings indicate that early varicocele repair improved semen parameters after surgery.     

Predictors of improved seminal characteristics by varicocele repair

The aim of this study was to investigate predictors of the improvement of semen characteristics after low ligation for patients with varicoceles. The records of 97 oligozoospermic patients who underwent microsurgical left or bilateral inguinal varicocele repair were retrospectively evaluated. We assessed factors that could be predictors of the improvement of semen characteristics using logistic regression analysis. We evaluated age, testicular volume, varicocele grade, serum follicle-stimulating hormone (FSH), luteinising hormone, testosterone, sperm concentration and motility before low ligation. Among the 97 patients, sperm concentration improved from 6.4 ± 5.8 to 24.2 ± 35.1 million ml⁻¹ and sperm motility increased from 32.8 ± 24.9% to 41.0 ± 14.6% in 55 patients (57%). In logistic regression analysis, pre-operative serum FSH and testosterone concentration were predictors of sperm concentration improvement. Varicocele repair improved sperm concentration and motility. Low serum FSH and high testosterone are significant factors predicting the improvement of semen characteristics before low ligation.     

The effect of varicocele repair on testicular volume in children and adolescents with varicocele

PURPOSE: We investigated the effect of varicocele repair on testicular volume according to age in children and adolescents and review the long-term results of varicocele surgery. MATERIALS AND METHODS: The study included 39 boys 11 to 19 years old with clinical palpable varicocele who underwent varicocele surgery with at least 1 year of postoperative followup. Preoperative and postoperative testicular volumes were monitored and measured with an ellipsoid Prader orchidometer. Physical examination findings (testicular volumes and testicular consistency) in all boys, and serum hormone values and semen parameters in 16 adolescents were recorded and compared before and after surgery. RESULTS: Left unilateral varicocelectomy was done in 29 boys (74%) and bilateral varicocelectomy in 10 (26%). While no postoperative hematoma, infection or testicular atrophy was observed, 1 boy (2.5%) had varicocele recurrence and 2 boys (5.1%) had minimal hydroceles that required no intervention. Significant increases were observed in postoperative sperm concentration (p = 0.01), total motile sperm count (p = 0.009), testis volume (p = 0.000) and serum testosterone level (p = 0.014). All 15 boys with preoperative soft testis had normal testicular consistency postoperatively. Of the 19 boys with preoperative testicular atrophy 10 (53%) did regain normal testicular growth, while 9 (47%) retained testicular volume loss after surgery. When comparing preoperative to postoperative increase in testicular volume according to age in all boys, the mean was statistically significantly higher in boys younger than 14 years (left testis p = 0.037, right testis p = 0.000). CONCLUSIONS: Testicular consistency achieved normal firmness after varicocelectomy in all boys with preoperative soft testis. While there was catch-up growth in comparison to the contralateral testis, testicular consistency improved but testicular volumes may not increase significantly after varicocele repair at ages older than 14 years. However, in these adolescents postoperative semen parameters and serum hormone values may significantly improve regardless of testicular volume. Therefore, boys with varicocele and their families should be fully informed in light of these findings.     

Adolescent varicocele: association with somatometric parameters

INTRODUCTION: The developmental changes that occur as a result of puberty have been hypothesized to be important causes of varicocele. Various somatometric parameters were known to affect the occurrence of varicocele during the growth period. We conducted this study in order to examine these relationships and to determine the incidence of varicocele in adolescent males. PATIENTS AND METHODS: We evaluated 1,200 healthy males aged 0-19 years for varicocele and correlated it with the following somatometric parameters: age, height, body mass index (BMI), pubic hair distribution, penile length and testicular volume. RESULTS: Adolescent varicocele was found in 5.6% of the participants. The 13- to 19-year age-group had the highest incidence of varicocele (10.5%). Logistic regression analysis showed that the incidence was positively correlated with age, height and penile length (odds ratio 1.61, 1.04 and 1.37, respectively) and negatively correlated with left testicular volume, BMI and pubic hair distribution (odds ratio 0.87, 0.87 and 0.47, respectively). CONCLUSION: Varicocele was more prevalent in tall boys with a lower BMI, who had quickly progressed through puberty. Our observations suggest that varicocele is associated with various somatometric parameters.     

Ultrasonographic parameters of the spermatic veins at the inguinal and scrotal levels in varicocele diagnosis and post-operative repair

Varicocele has been identified as an important cause of male infertility where its influence on men's reproductive capacity is due to its markedly diverse effects on the testicles. This study aimed to assess the value of ultrasonographic parameters of the spermatic veins at the inguinal and scrotal levels in varicocele diagnosis and post-operative evaluation. Forty-five infertile men associated with varicocele and 15 fertile men were subjected to history taking, genital examination and semen analysis. In addition, inguinal and scrotal ultrasonography was carried out pre-varicocelectomy and 3 months post-varicocelectomy. At both the scrotal or inguinal levels, the mean spermatic vein diameter demonstrated significant post-operative decrease compared with the pre-operative resting condition and on Valsalva' manoeuvre. The mean diameters of the pampiniform plexus of veins also demonstrated significant decreases post-operatively compared with the pre-operative resting condition or on Valsalva' manoeuvre. It is concluded that colour Doppler ultrasound is a reliable and noninvasive method that is useful not only for diagnosis but also for post-varicocele repair follow-up.     

Improvement of semen characteristics after surgical repair of bilateral testicular varicocele as compared to unilateral varicocele patients

The operative treatment for surgical repair of bilateral testicular varicoceles was evaluated in terms of the improvement achieved in the sperm density and percentage progressive motile sperm. These parameters were compared for 27 cases of bilateral varicocele diagnosed by palpation and subjected to bilateral high ligation of the internal spermatic vein and for 40 cases of left unilateral testicular varicocele. There were no significant differences in preoperative values (such as sperm density; progressive motile sperm; serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone; and Johnson's score count) between the bilateral and unilateral testicular varicocele groups. The improvement in postoperative sperm density in the cases with bilateral testicular varicocele was apparently less satisfactory than in the cases with testicular varicocele only on the left side.     

Induction of spermatogenesis by inguinal varicocele repair in azoospermic men

13 infertile patients who had complete azoospermia and clinical varicocele underwent inguinal varicocele repair. Semen analyses were obtained starting 3 months after varicocele repair. Bilateral varicocele repair in 2 men and unilateral in 11 men were performed. Induction of spermatogenesis was achieved in 3 (23%) patients. Two of them had hypospermatogenesis and one had maturation arrest at spermatid stage. No pregnancies by natural intercourse resulted. Although one couple used fresh ejaculate for intracytoplasmic sperm injection, the result was unsuccessful. All men with Sertoli cell-only and early maturation arrest remained azoospermic after surgery. No association between successful outcome and patient age, sex hormone analysis, varicocele grade, testicular volume, unilateral or bilateral varicocele repair were apparent. Varicocele repair can result in the induction of spermatogenesis for men with hypospermatogenesis and late maturation arrest. No other related factor could be detected.     

Adolescent varicocele: Tauber antegrade sclerotherapy versus Palomo repair

PURPOSE: There is general agreement on treatment for varicocele in pediatric patients. Randomized prospective studies have shown that anatomical and functional lesions may be corrected. Due to the impossibility of seminal examination patients with moderate to large varicocele or ipsilateral testicular hypertrophy, characterized by a change in testicular consistency or symptoms, should undergo surgical correction. The best therapeutic approach is still under discussion. MATERIALS AND METHODS: At 2 centers 2 therapeutic approaches to varicocele treatment in pediatric patients were compared, namely the Palomo repair and antegrade sclerotherapy according to Tauber. The 89 patients from the same geographical area elected 1 procedure after an explanation. From the medical records we retrospectively evaluated operative time, postoperative analgesics, postoperative fever onset, complications, convalescence, recurrence and postoperative hydrocele. RESULTS: After Palomo repair in 45 patients there were 2 recurrences (4.4%) and 2 postoperative hydroceles (4.4%). Of 44 antegrade sclerotherapy cases 1 was converted to Palomo repair, there was no hydrocele formation and recurrence developed in 2 (4.5%). Testicular atrophy was not observed in any patient regardless of the method used. The cost of the procedure was lower in the sclerotherapy group. CONCLUSIONS: These data suggest that the failure rate was similar in both groups. The principal advantages of sclerotherapy are simplicity, decreased cost and lack of hydrocele formation.     

Incidence and clinical significance of arterial injury in varicocele repair

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

• ? This study was performed to histologically determine the rate of arterial injury in varicocele ligation surgery and to determine the clinical significance of these arterial injuries.

MATERIALS AND METHODS

• ? 41 men who underwent varicocele ligation surgery, and had segments of each ligated vessel examined histologically.
• ? The patients were followed prospectively to determine the effect of arterial injury on surgical results and clinical complications.

RESULTS

• ? Arterial ligation was identified in 6 of 41 patients (12%), and in 7 of 132 specimens (5%), which is higher than previous reports.
• ? Arterial injury was not associated with testicular atrophy and there was no apparent effect of arterial injury on surgical outcome.

CONCLUSION

• ? The rate of arterial injury during varicocele repair is higher than previously reported, but the clinical significance of these injuries appears to be limited.

     

Predictive parameters for microsurgical reconstruction

Microsurgical techniques have made vasectomy reversal a realistic option for the restoration of fertility in a man who has previously undergone vasectomy. Factors that can affect the success of these procedures may become known preoperatively and intraoperatively; this article reviews each of those factors.     

Freeze-thaw parameters in successful renal cryopreservation

Freeze-thaw parameters defining successful renal cryopreservation have not been available previously. From this study of kidneys frozen solid to a renal core temperature of ?22°C and thawed, which were capable of sustaining the dog's life after contralateral nephrectomy, the following freeze-thaw parameters have been noted. Freeze rates of less than 1°C/min are unsuccessful, success being achieved at rates of 1–2°C/min when using thaw rates exceeding 70°C/min achieved with a microwave unit. Thaw rates less than this were not successful even with the faster freeze rate.