Abstract
BackgroundVaricocele is a condition characterized by dilated, tortuous veins within the pampiniform venous plexus of the scrotal sac. Presence of varicocele is associated with an increased risk of alteration of semen parameters. The objective of this study was to compare the current standard in varicocele treatment procedures: sub-inguinal microscopic ligation to percutaneous embolization in terms of semen parameters improvement, fertility, and morbidity at the university hospital of Toulouse (France). Seventy six patients with clinical varicocele, alteration of semen parameters and infertility, underwent either procedure (microsurgery in 49 case performed by a single surgeon and embolization in 27 cases) and were prospectively analyzed. Outcome measures were: semen parameters, spontaneous pregnancies, pain, side effects, recovery time and overall satisfaction. All patients were contacted in January 2015 in order to determine reproductive events.ResultsPreoperatively, there was no difference in clinical and biological items between the two groups. Postoperatively, on the overall population, there was a significant improvement of sperm concentration at 3, 6, 9 and 12 months (p = <0.001, <0.001, 0.012, 0.018) and sperm motility at 6 months (p = 0.002). The sperm concentration was higher at 6 months in the percutaneous embolization group (13.42, vs. 8.1×106/ml; p = 0.043). With a median follow-up of 4 years, 27 pregnancies occurred (spontaneous pregnancy rate of 35.5%).There was no significant difference between procedures on the sperm quality, pregnancy rate, and the overall satisfaction. Patients undergoing percutaneous embolization reported a faster recovery time (p = 0.002) and less postoperative pain (p = 0.007).ConclusionOur study shows that percutaneous embolization seems to be an equivalent alternative to sub-inguinal microscopic ligation in term of sperm quality improvement, pregnancy rate, and overall satisfaction with a slight advantage on post-operative morbidity.
Highlights
Varicocele is a condition characterized by dilated, tortuous veins within the pampiniform venous plexus of the scrotal sac
Recent studies showed that it resulted mainly in higher levels of reactive oxygen species (ROS) [2,3,4]. This excessive ROS is associated with sperm DNA fragmentation, which may mediate the clinical manifestation of poor sperm function and fertilization outcome related to varicocele [5, 6]
Inclusion criteria were: 1) clinical varicocele; 2) couple infertility for at least one year, 3) at least one abnormal semen parameter confirmed by two semen analyses within an interval of three weeks, 4) absence of other contributing male risk factors and 5) female partner considered fertile at the date of evaluation
Summary
Presence of varicocele is associated with an increased risk of alteration of semen parameters. Varicocele is a condition characterized by dilated, tortuous veins within the pampiniform venous plexus of the scrotal sac. It is a fairly common condition, accounting for 35% of men with primary infertility and 75–81% of men with secondary infertility [1]. Recent studies showed that it resulted mainly in higher levels of reactive oxygen species (ROS) [2,3,4] This excessive ROS is associated with sperm DNA fragmentation, which may mediate the clinical manifestation of poor sperm function and fertilization outcome related to varicocele [5, 6]. For Shiraishi K. et al the oxidative stress is due to the increased scrotal temperature and not directly associated to varicocele grade, causing a disturbance of the oxidative stress scavenging system in infertile men with varicoceles [7, 8]
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