(271) Assessment of Varicocele Bilaterality in Infertile Men

Abstract

Abstract Introduction Varicocele is the most common correctable cause of male factor infertility. It has always been a debatable subject as regard how it affects fertility and the best way to treat. However, there is a wide consensus nowadays that varicocelectomy improve male fertility potentials. Proper assessment of the disease bilaterality is crucial not to miss one side and not to jeopardize treatment outcome. Objective The primary outcome measure was to assess disease bilaterality and the secondary outcome measure was to report on improvement in semen 3 and 6 months post varicocelectomy and pregnancy rate 1 year post surgery. Methods This prospective study was conducted between January 2019 and January 2022. Infertile males with varicoceles underwent microsurgical subinguinal varicocelectomy by expert uroandrologists. Patients who were referred as unilateral varicoceles had their CDUS repeated for assessment of missed concomitant contralateral varicocele. Then, patients who were diagnosed with bilateral varicoceles underwent bilateral subinguinal ligation straight away. Those who were referred with unilateral varicocele had their palpable sides operated on first; then the contralateral side was also explored using an intraoperative Doppler device and the maximal vein diameter was measured. Patients came for follow for at least 6 months after surgery to evaluate any complications and assess improvement in semen parameters. Gynecologists also reported on normal pregnancy rate 1 year after surgery. Results A total of 329 cases completed the study. A hundred cases (30.4%) were initially referred as unilateral varicoceles and 229 (69.6%) as bilateral varicoceles. After reassessment of the study population, bilaterality of varicocele was found to be as high as 98.5% (324/329). This is statistically significantly higher than initial US (P<0.001). Repeat CDUS strongly correlated with the intraoperative measured varicocele diameter [r=0.9, P<0.001]. Moreover, sperm parameters showed significant improvement 3 and 6 months post varicocelectomy. Normal pregnancy after 1 year of surgery occurred in 118 cases (35.9%). Conclusions Varicocele bilaterality is underreported. Thorough assessment by expert radiologists and andrologists is of paramount importance not to miss significant pathology or hazard treatment outcome. Disclosure No.