PD24-03 A PREOPERATIVE PROGNOSTIC NOMOGRAM FOR PREDICTING CHANGES IN SEMEN PARAMETERS IN INFERTILE MEN AFTER VARICOCELE REPAIR

Abstract

You have accessJournal of UrologyInfertility: Therapy1 Apr 2014PD24-03 A PREOPERATIVE PROGNOSTIC NOMOGRAM FOR PREDICTING CHANGES IN SEMEN PARAMETERS IN INFERTILE MEN AFTER VARICOCELE REPAIR Mary Samplaski, Changhong Yu, Michael W. Kattan, Kirk Lo, Ethan Grober, and Keith Jarvi Mary SamplaskiMary Samplaski More articles by this author , Changhong YuChanghong Yu More articles by this author , Michael W. KattanMichael W. Kattan More articles by this author , Kirk LoKirk Lo More articles by this author , Ethan GroberEthan Grober More articles by this author , and Keith JarviKeith Jarvi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1994AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In most men with abnormal semen parameters, varicocele repair results in improved semen parameters. However, there is no way to predict which men will respond and the expected seminal changes. We formulated a nomogram to predict improvements in post-varicocele repair semen parameters, based on pre-repair varicocele characteristics and semen parameters. METHODS Men presenting for a fertility evaluation from 2008-2012 undergoing varicocele repair (surgical or radiographic embolization) were identified via a prospectively collected database. The improvement in semen parameters after repair were modeled using multivariable linear regression models based on patient age, varicocele grade on the L or R, mean pre-repair ejaculate volume (mL), total motile sperm count (TMC) (million), motility (%), and normal morphology (%). Model performance was quantified by concordance correlation coefficient (CCC) and Pearson correlation coefficient after internal validation. RESULTS 383 men underwent varicocele repair. 315 (82.2%) were repaired microsurgically and 68 (17.8%) via radiologic embolization. Left-sided varicoceles were present in 198 (51.7%), and bilateral varicoceles in 178 (46.5%). Predictors for post-repair TMC were: L varicocele grade, ejaculate volume, concentration and motility. Predictors for post-repair sperm concentration were: L varicocele grade, sperm concentration and motility. Predictors for post-repair sperm motility were: age, L varicocele grade, motility, normal morphology and TMC. Predictors for post-repair sperm morphology were: age, R varicocele grade, normal morphology and TMC. Nomograms to predict post-repair TMC (Figure 1), sperm concentration, motility and morphology were constructed. These nomograms proved to be accurate as quantified by CCC and Pearson’s correlation for all models based on 1000 bootstrap resamples. The CCCs were 0.45, 0.47, 0.65 and 0.36 for sperm concentration, mobility, morphology and TMC respectively. CONCLUSIONS Clinical factors provide substantial predictive ability to predict post-varicocele repair semen parameters. These nomograms may be used by clinicians to predict improvements in post-varicocele repair semen parameters, based on pre-repair varicocele characteristics and semen parameters. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e731-e732 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mary Samplaski More articles by this author Changhong Yu More articles by this author Michael W. Kattan More articles by this author Kirk Lo More articles by this author Ethan Grober More articles by this author Keith Jarvi More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...