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Abstract

Varicocele is a common pathology among the whole male population, regarding 10%-35% of healthy adult men and adolescents. There is a clear evident relationship between varicocele and subfertility/infertility; however, whether varicocele treatment improves fertility is highly debated among the international literature. Several studies have attempted to relate many patient parameters with differences in sperm quality improvement. The most frequently studied parameters are varicocele size, numbers of veins ligated, age of patients at intervention, and the clinical or only instrumental evidence of varicocele before its correction. A clear correlation between pathogenetic mechanisms of testicular damage and some preoperative parameters predicting a better outcome is still lacking. Our study's goal was to analyze the main factors that can help urologists in selecting patients who will probably undergo a better improvement in seminal parameters after varicocele sclerotization. The main factors analyzed were varicocele grade and age of patients. The importance of the grade is its strict connection with varicocele pathogenesis, whereas the analysis on patient age is helpful in deciding whether treatment on older patients loses its therapeutic outcome on their fertility. Our results clearly showed a significant improvement in semen quality by treating all patients, and their age was not related to any difference. The only strongly significant parameter showing a clear difference in spermatic results was the presence of renospermatic venous basal reflow, identified with varicocele grades 4 and 5. Therefore, we recommend the treatment of varicocele for infertile patients of every age, even those aged more than 40 years, especially if their varicocele is fourth or fifth grade using Sarteschi classification. Editorial CommentUrologyVol. 75Issue 5PreviewThis is a prospective study using patients as their own control to analyze the predictive significance of renospermatic basal reflow on color Doppler ultrasound on sperm concentration, motility, and morphology. A total of 113 men were selected based on the presence of a unilateral left varicocele. The appropriate exclusion criteria were used. Renospermatic basal reflow was categorized using the classification schema of Sarteschi, which assesses internal spermatic vein size and level of reflow in the supine and standing position with and without Valsalva. Full-Text PDF