Microsurgical Varicocelectomy Research Articles

Comparative evaluation of visual-palpatory findings with scrotal doppler ultrasound data for varicocele diagnosis

Introduction. Current evidence suggests that management of any grade of varicocele can improve male fertility. However, diagnosis of grade 1 varicocele in infertile men without the use of scrotal Doppler ultrasound may cause overtreatment.Objective. To study the comparability and accuracy of the visual palpatory examination method with the scrotal Doppler ultrasound data for the diagnosis of varicocele.Material & methods. Between November 2005 to January 2022, 2871 patients diagnosed with varicocele and infertility who underwent microsurgical varicocelectomy by inguinal access were examined at RSSPMCU. The average age of the patients was 30.16 ± 0.09 (18 – 60) years. Of the 2871 patients, 2592 (90.3%) were diagnosed by physical examination, and 279 (9.7%) patients underwent additional scrotal Dopper ultrasound.Results. After Doppler scrotal imaging was introduced into practice, the proportion of patients with bilateral varicocele increased from 32.2% to 61.6% (p < 0.01). The proportion of patients with right-sided varicocele also increased significantly. Experienced physicians during physical examination of infertility patients did not diagnose grade 1 varicocele in 4.3%.Conclusions. The implementation of scrotal Doppler ultrasound for the diagnosis of male infertility improved the detection of grade 1 varicocele and bilateral varicocele. In turn, this contributed to earlier elimination of the male factor of infertility in this contingent of patients.

(O-08) IMPACT OF SUBINGUINAL MICROSURGICAL VARICOCELECTOMY ON MALE INFERTILITY: SEMINAL PARAMETERS, SERUM TESTOSTERONE, AND PREGNANCY RATE - RETROSPECTIVE COHORT AT A UNIVERSITY HOSPITAL IN RIO DE JANEIRO

Abstract Introduction and Objective Varicocele is the most common identifiable cause of male infertility, and varicocelectomy is the most frequently performed surgery for its treatment. This condition impacts infertility cases and sperm quality. Microsurgical varicocelectomy is considered the gold standard treatment for varicocele. This retrospective cohort aims to evaluate the effects of microsurgical varicocelectomy on seminal parameters, serum testosterone, and pregnancy rate in the context of male infertility in 39 patients who underwent the procedure at a university hospital in Rio de Janeiro. Methods This study is a retrospective cohort conducted between January 2016 and February 2023, involving 39 men who underwent subinguinal microsurgical varicocele repair in the context of marital infertility. Pre- and post-operative analyses of seminal parameters were based on the criteria of the World Health Organization from 2010. Post-operative semen analysis and serum testosterone levels were assessed 3 to 6 months after varicocelectomy. The pregnancy rate was observed through interviews until February 28, 2023. Results Subinguinal microsurgical varicocelectomy is associated with a significant increase in testosterone levels and an improvement in seminal parameters, all with statistical significance. Testosterone levels increased by an average of 84.2 (±14.7) ng/dl. The pregnancy rate also increased significantly, with 51.3% of couples achieving pregnancy as of the time of this study. Conclusion In this patient population, infertile men with clinical varicocele who underwent subinguinal microsurgical varicocelectomy showed a significant increase in testosterone levels, improvement in seminal parameters, and a significant reduction in the proportion of azoospermia. Furthermore, there was an increase in the occurrence of pregnancy in couples with marital infertility. Statistical Results Financing No conflict.

Video-Assisted Telescope Operating Monitor 3D System in Microsurgical Varicocelectomy: A Preliminary Report.

Video-assisted telescope operating monitor (VITOM®) with 3D Visualization technology was developed and has been used with favorable results by several surgical specialties. Our study aims to be a preliminary report for initial experience using the VITOM® 3D system for microsurgical varicocelectomy on varicocele patients. We performed 35 microsurgical varicocelectomy procedures using the VITOM® 3D system on varying types and grades of varicoceles. The surgeon had the option of using either a 2.5 or 3.5 magnifying loupe in addition to the exoscope for each operation evaluated. The exoscope is a standalone camera head with an integrated 3D telescope and remote control with zoom and focus functions. It is connected to the 3D monitor via a mechanical holding arm. During the procedure, surgeons, assistants, and observers were able to view the 3D high-definition stream displayed on a 26-inch 3D monitor at a convenient viewing angle and distance. The varicocele ligation was performed using a Carl Zeiss Meditec AG microscope. There were 35 patients with varicocele aged 31.51years old on average, which were included in this report. Most patients had grade 3 bilateral varicocele (n = 13, 37.1%). All procedures were performed without any intraoperative complications. After the procedures, only a few patients suffered from postoperative complications. Three patients suffered scrotal edema (8.6%), while another had hydrocele (2.9%). The postoperative pain results were also very minimal from .89 1day after the operation to .26 3days after the operation. The VITOM® 3D system showed promise in microsurgical varicocelectomy.

(271) Assessment of Varicocele Bilaterality in Infertile Men

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.

Microsurgical varicocelectomy efficacy in treatment of men with primary and secondary infertility (retrospective study).

Varicocele is the most common treatable cause of male infertility. The study aimed to compare varicocelectomy efficacy in men with primary (PI) and secondary infertility (SI). Medical records of 100 men suffering from PI and SI and having varicocelectomy at the Republican Specialized Scientific-Practical Medical Center of Urology were retrospectively selected and analyzed. Patients were divided into 2 groups. Group I included 58 men with PI and Group II 42 men with SI. Preoperative clinical characteristics and semen parameters before and after varicocelectomy were analyzed and compared between groups. Analysis revealed that the mean age of patients of group I was significantly lower (p < 0.001) and the duration of infertility was accurately shorter (p < 0.01) than those of group II. Main semen parameters increased significantly in group I (e.g., sperm concentration increased by 50%, from 62.2 ± 8.7 to 93.5 ± 10.0 M/ml, and total motile sperm count increased by 113%, from 76.7 ± 17.1 to 163.4 ± 27.8 M p < 0.05), while in group II only rate of progressive motile sperm increased significantly (by 107%, from 13.5 ± 2.6 to 28.0 ± 5.2% p < 0.05). We identified a significant difference in varicocelectomy efficacy between group I and group II in change of total motile sperm count (by 113% vs. 74% respectively, p < 0.01). We also revealed a discrepancy between groups in correlation ratio (r) between initial and post-surgical percent of progressive motile sperm. Patients with SI were older and had longer infertility period. Varicocelectomy resulted in significant semen parameters improvement in patients with PI. In patients with SI, only percent of progressively motile sperm improved significantly. It indicates that advanced male age and long infertility duration may have a negative impact on varicocelectomy success.

(337) Microsurgical Varicocelectomy Improves Seminal Parameters in Infertile Men: 10-year Experience in a University Hospital

Abstract Introduction Varicocele is the most common treatable cause of male infertility. Although the exact mechanisms by which varicocele causes infertility have not been fully identified, there is evidence of an improvement in seminal parameters and pregnancy rates after varicocelectomy, especially if the technique is performed with an operating microscope Objective This study seeks to compare pre- and post-operative seminal and hormonal parameters of infertile patients undergoing microsurgical varicocelectomy in a local cohort Methods Retrospective analytical study of male patients with a diagnosis of infertility and clinical varicocele, who underwent microsurgical varicocelectomy in a University Hospital, between April 2013 - April 2023. Demographic variables, varicocele grade and laterality, reproductive hormone levels, seminal parameters and postoperative complications were collected from the clinical history database. Pre and postoperative seminal parameters and reproductive hormones were compared using non-parametric statisticians were used for data analysis with the Jamovi Software. P&amp;lt;0.05 was considered statistically significant Results There were 136 varicocelectomies in the period, 56 patients were excluded due to incomplete data collection and finally 80 patients were analyzed. Median age was 34.5 years (IQR 31-38), with a median infertility duration of 2 years (IQR 1-4). All patents had primary infertility. The median testicular volume was 15 cc (IQR 15-20 cc). 82.5% of varicoceles were Grade ≥2, 70.6% patients presented left varicocele and 28% were bilateral. Of the reproductive hormones, only FSH showed a statistically significant decrease of the pre- and post-operative median values, being 5.8 IU/L (IQR 3.9-8.9) and 2.7 IU/L (IQR 2.5-2.9) (p=0.001), respectively. Median sperm concentration before and after surgery was 7 million/mL (IQR 2-23) and 18 million/mL (IQR 3.3-73.5), respectively (p=0.02). Median preoperative and postoperative sperm progressive motility was 29% (IQR 15-48) and 40% (IQR 27-60), respectively (p=0.004). Seminal volume and normal morphology did not show significative changes after surgery. Only 2 patients (2.5%) presented a grade 1 Clavien-Dindo postoperative complication (mild infection of surgical site) Conclusions In this study, infertile patients with a clinical diagnosis of varicocele showed a statistically significant improvement in sperm concentration and progressive motility and a significant decrease in FSH levels after microsurgical varicocelectomy. The reduction of this pituitary hormone may reflect an improvement in testicular spermatogenesis Disclosure No.

(256) Effect of Early Varicocelectomy Intervention on Male Hormone Levels in Adolescent Males

Abstract Introduction Varicoceles can be found in approximately 15% of the adult male population and are known to impact male fertility. Varicoceles may develop during adolescence and increase in size as these males undergo puberty. According to current guidelines, it is recommended to monitor young asymptomatic patients and consider surgical intervention if they develop testicular size discrepancies, fertility issues, abnormal semen analyses, or experience significant pain. However, the effect of varicoceles on sex hormones and management in young males is poorly understood. Objective To evaluate the impact of early surgical intervention for varicoceles with a microsurgical varicocelectomy on hormone levels and safety profiles in adolescent males. Methods A retrospective review was conducted on 67 patients between the ages of 10 and 17 years old who had a grade 2 (G2) or grade 3 (G3) varicocele, and underwent microsurgical varicocelectomy between November 2021 and May 2023. Patient demographics, varicocele laterality and grade, surgical data, and pre-and post-operative hormone levels were collected as well as post-operative complications. Hormonal panel was collected before 11AM using LCMS and included total testosterone (TT), free testosterone (FT), percent free testosterone (%FT), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (P), and sex hormone-binding globulin (SHBG). Statistical analyses were conducted using SAS System. Results A total of 67 patients had complete data (96% had G3 varicoceles). Preoperative FT was statistically significant between varicocele grades 2 and 3 (p=0.03) with G3 varicoceles having lower preop FT levels. Pre-operative hormone levels for G2 varicoceles were: TT 550ng/dL (std 177ng/dL), FT 126ng/dL (std 27), E2 33 (std 2.64), FSH 3.53 (std 1.27) and LH 5.06 (std 3.53). Pre-op levels for G3 varicoceles: TT 437ng/dL (std 199ng/dL), FT 71.3 (std 42.2), E2 25.2 (std 9.64), FSH 4.34 (std 3.3) and LH 3.73 (std 1.9). Post operatively TT levels improved in G3 varicocelectomy patients with a postop mean TT 445ng/dL (std 109ng/dL), however this did not meet statistical significance. There was no statistically significant difference between postoperative hormone panel labs between varicocele grades. There were no complications in any of the patients and no recurrence of varicoceles. Conclusions Our study evaluated the impact of early surgical intervention for G2 and G3 varicoceles on hormone levels in adolescent males. The results showed a significant difference in preoperative Free T levels between G2 and G3 varicocele patients possibly indicating the impact of varicocele grade on FT levels in adolescents. Early surgical intervention for G3 varicoceles appears to be safe with resultant improvements in TT levels with no increased risk of complications. Further investigations to explore the potential benefits of early surgical treatment in adolescent patients with varicoceles evaluating hormonal profiles in larger cohorts. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast and BK Ultrasound.

Comparison of the pulling technique versus the standard technique in microsurgical subinguinal varicocelectomy: a randomized controlled trial

BackgroundWe compare the outcome of microsurgical subinguinal varicocelectomy (MSV) using the pulling technique (P-MSV) compared to the standard technique (S-MSV).MethodsA total of 60 patients were diagnosed with varicocele compounded with infertility and/or scrotal pain not responding to medical treatment. Twenty-nine patients were randomized to the P-MSV, while 31 were randomized to S-MSV. The number of ligated veins was counted intraoperative and compared. Follow-up was done at 1 and 3 months including clinical examination, scrotal duplex ultrasound scan, and semen analysis.ResultsA total of 85 sides were operated upon, 43 (50.5%) were done by the P-MSV technique while 42 (49.5%) were done by the S-MSV technique. The median gained cord length after using the P-MSV was [3 cm; IQR 2–5 cm]. For the P-MSV technique, the mean number of detected internal spermatic veins after cord pulling was (4 ± 1.3 SD) compared to (6 ± 1.4 SD) before pulling (P value < 0.01) and for the S-MSV was 3 (2.75–5). There was no statistical or clinically significant difference in the perioperative outcomes between both groups. The overall conception rate was 47.1%. Ninety-two percent of patients complaining of preoperative scrotal pain had resolution of the pain on follow-up with no statistical difference between both techniques (P values 0.53, 0.3 respectively). There was no statistical difference in the recurrence rate between both groups (P = 0.11). The number of ligated veins decreased significantly using the P-MSV technique leading to an improvement in the surgical feasibility of MSV.ConclusionThere is a significant benefit for the new pulling technique in decreasing the number of internal spermatic veins which leads to improving the surgical feasibility of microsurgical varicocelectomy.

Vitamin E supplementation after microsurgical varicocelectomy: Does it make sense?

Vitamin E supplementation after microsurgical varicocelectomy: Does it make sense?

P270 - RETRACTED: Which factors have an impact on fertility outcomes of microsurgical varicocelectomy?

P270 - RETRACTED: Which factors have an impact on fertility outcomes of microsurgical varicocelectomy?

Comparison between Microsurgical Varicocelectomy with and without Testicular Delivery for Treatment of Varicocele: An Updated Systematic Review and Meta-Analysis

Dilated testicular gubernacular veins after varicocelectomy were reported to be the cause of varicocele recurrence. The gubernacular veins start at the tail of the testicular and merges into the posterior scrotal veins. The gubernacular veins could be ligated only after testicular delivery (TD) anatomically. TD and ligation of the gubernacular veins during microsurgical varicocelectomy might reduce the varicocele recurrence but this method is still under debate. Therefore, we performed this systematic review and meta-analysis and assessed varicocele recurrence, complications as well as clinical outcomes after microsurgical varicocelectomy with TD. Relevant researches were searched on the PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure databases to perform an updated meta-analysis. Standardized mean differences, relative risks (RRs), and their 95% confidence intervals (CIs) were applied to evaluate result indicators. This updated meta-analysis included 17 publications with 10 randomized controlled trials and 7 cohort studies. A total of 2,254 participants, including 1,024 subjects with TD and 1,230 without TD, were involved. The pooled results demonstrated that microsurgical varicocelectomy with TD might lead to higher incidences of postoperative scrotal edema (RR = 4.20, 95% CI = 2.60–6.81, p &lt; 0.001 ), testicular hydrocele (RR = 6.58, 95% CI = 1.19–36.20, p = 0.030 ), and orchiepididymitis (RR = 6.33, 95% CI = 2.08–19.31, p = 0.001 ) than the group without TD. Similar findings were also found in subgroup analysis of varicocele grade II and III. By contrast, we failed to find significant differences between them in semen parameters, varicocele recurrence, serum testosterone, and natural pregnancy ( p &gt; 0.05 ). Sensitivity analysis revealed the pooled results were stable and no publication bias was detected. TD during microsurgical varicocelectomy may lead to more postoperative complications and may not be beneficial for semen parameters, recurrence of varicocele, and natural pregnancy. Therefore, varicocele patients may not benefit more from TD.

Assessment of semen parameters after microsurgical varicocelectomy in men from infertile couples

Introduction. Varicocele is one of the frequently identified and corrected causes of male subfertility. However, varicocele correction results in improved sperm quality only in 60 – 70% of subfertile men. At the same time, it is not completely clear which semen parameters improve to a greater extent, and what is the proportion ofpatients with an improvement in parameters to normozoospermia.Objectives. To assess qualitative changes in semen after microsurgical varicocelectomy according to WHO 2021 Laboratory manual of semen analysis.Materials &amp; methods. This study analysed qualitative changes in sperm in infertile men after varicocelectomy. All patients had a clinical varicocele, for which microsurgical varicocelectomy was performed. The study included 100 subfertile men with varicocele and abnormal sperm parameters.Results. In the postoperative period (after 6 months), the main semen parameters increased significantly. Also, the proportion of patients with isolated asthenozoospermia decreased by 22% (p &lt; 0.05), the proportion of patients with oligoasthenozoospermia decreased by 14% (p &lt; 0.05). The proportion of patients with normospermia was 35% (p &lt; 0.0001). In patients with oligoasthenozoospermia significant improvement in sperm to normospermia was observed in 19% of cases.Conclusions. Varicocele repair leads to an improvement in the quality of the ejaculate in subfertile men with palpable varicocele and pathozoospermia, with the most significant improvement in sperm motility. However, only in a third of patients semen quality improved to normal levels. Additionally, varicocelectomy demonstrated high efficacy in patients with oligoasthenozoospermia.

Редкий этиологический фактор варикоцеле.

Introduction. Varicocele is detected in 15% of healthy men, in 35% – with primary and in 80% – with secondary infertility. At the moment, microsurgical varicocelectomy by sub-inguinal access is one of the most effective ways to treat varicocele in adult patients. Currently, there is no comprehensive data on the optimal treatment of varicocele recurrence. According to Russian clinical guidelines, testicular vein thrombosis is an extremely rare cause of varicocele development in the practice of a urologist. Material and methods. From November 2018 to February 2023, 118 patients were operated on for varicose veins of the scrotum organs. For all patients with the underlying disease, surgical aid was performed in the amount of micro-surgical subinguinal dissection of the testicular veins from the affected side (sides), or Marmara surgery. Results. The average duration of the operation was 46±11.3 minutes. In all the subjects, the period of hospitalization did not exceed one day. Complications in the postoperative period (according to the Cavien-Dindo scale) were not detected in any of the patients. The severity of the pain syndrome was determined by the VAS scale, and amounted to 0.78 ± 0.6 points. The average dose of non–narcotic analgesics (ketorolac, single dose – 30 mg) was 7.38 ± 3.63 mg. Recurrence of varicocele after microsurgical subinguinal dissection of testicular veins was recorded in 1.7% of patients. Conclusions. Marmara surgery is an effective method of surgical treatment of varicocele in spontaneous thrombosis. Recurrence of varicocele after microsurgical sublingual dissection of the testicular veins was recorded in 1.7% of patients. Spontaneous thrombosis of the branch of the testicular vein is a rare etiological factor of varicocele. The Marmara operation is an effective method of surgical treatment of varicocele with spontaneous thrombosis of the testicular vein.

Increased intraoperative vein ligation in microsurgical varicocelectomy is associated with pain improvement.

Varicocele is a major cause of male infertility. However, few studies have discussed the potential associations between the pain caused by varicocele and preoperative and intraoperative factors. The aim of this study was to evaluate factors potentially associated with changes in pain score after microsurgical varicocelectomy. This retrospective study was conducted between August 2020 and August 2022 at China Medical University Hospital in Taichung, Taiwan. Patient characteristics including age, body mass index, semen analysis, testicular volume, and the number of veins ligated were collected. Preoperative and intraoperative factors were analyzed to determine if they were correlated with changes in numeric rating scale (NRS) after microsurgical varicocelectomy. A total of 44 patients with clinical varicocele underwent subinguinal microsurgical varicocelectomy and were analyzed. The overall pain resolution rate was 91%, and the average satisfaction score after surgery was 9.2 according to their subjective feelings. Multivariate analysis revealed that severe varicocele grade (odds ratio [OR] 16.5, 95% confidence interval [CI] 3.01-90.47; P = .018) and the number of veins ligated (OR 6, 95% CI 1.6-22.48; P = .013), were significantly associated with changes in NRS after surgery. In addition, the area under the receiver operating characteristic curve for changes in NRS and the total number of veins ligated was 0.869. Microsurgical varicocelectomy had a high success rate for scrotal pain and satisfaction. Severe varicocele grade and the number of veins ligated in microsurgical varicocelectomy were associated with postoperative pain improvement.

Seminal TEX101 May Predict Seminal Sperm Recovery after Varicocelectomy in Nonobstructive Azoospermic Patients with Varicocele

Background. Infertile men with nonobstructive azoospermia (NOA) associated with varicocele may benefit from varicocele repair with recovered sperms in semen. Currently, there is no clinically applied method to predict the success of seminal sperm recovery in this subset of azoospermic men. Objective. We aimed to evaluate the predictive role of the seminal testis expressed protein (TEX101) in sperm recovery in the semen of NOA men with palpable bilateral varicocele after microsurgical varicocelectomy. Patients and Methods. This prospective cross-sectional cohort study included 40 patients with NOA and bilateral varicocele. Seminal TEX101 levels were measured followed by subinguinal microsurgical varicocele repair. Two seminal analyses were carried out at 3- and 6-month follow-up periods to evaluate seminal sperm recovery. Results. After varicocele repair, sperms were recovered in the semen of 10/40 patients (25%) along the follow-up periods (seven patients after 3 months and additional three patients after 6 months). The preoperative median seminal TEX101 level was significantly higher in NOA men with seminal sperm recovery compared with NOA patients without seminal sperm recovery (13.5 vs. 9.8 ng/ml, p = 0.014 ). Besides, the serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) median levels were significantly higher in NOA men without seminal sperm recovery compared with NOA men with seminal sperm recovery ( p = 0.001 , p = 0.01 ). There were nonsignificant differences comparing the preoperative testicular volume or serum testosterone levels between the two investigated groups ( p = 0.072 , p = 0.272 ). A cutoff value of 9.9 ng/ml was demonstrated to have preoperative TEX101 prediction of seminal sperm recovery (sensitivity of 90% and specificity of 57%). Conclusion. Preoperative seminal TEX101 could be considered as a biomarker for sperm recovery for seminal sperm recovery in NOA cases associated with varicocele after its surgical repair. Further work at this point with larger number of cases should be carried out to verify its potential importance.

Lipidomic analysis of seminal plasma in work-up of varicocele-associated male infertility

Background. Approximately 50 % of cases of infertility in couples are attributable to male factor. One of the most common causes of male infertility is varicose dilation of pampiniform plexus veins in spermatic cord, or varicocele. However, the fact that only in 10-45 % of cases microsurgical subinguinal varicocelectomy leads to a spontaneous pregnancy in a couple urges further search for a diagnostic marker which would be able to predict the success of surgical treatment of varicocele preoperatively.Aim. To study the features of lipid profile of seminal plasma in patients with varicocele and to evaluate the possibility of using lipidomic analysis of seminal plasma for patient selection prior to surgical treatment for varicocele.Materials and methods. Fifty three patients from infertile couples with varicocele and altered seminal parameters aged 18 to 44 years underwent microsurgical varicocelectomy as described by Marmar. All patients were treated in one department. The control group included 24 healthy normozoospermic men without varicocele who had proven fertility. The material for the study was the seminal plasma of men, lipid composition of which was determined by mass spectrometry.Results. No significant differences were found in lipid profiles of seminal plasma from men in control group and varicocele group, as well as in lipid profiles of seminal plasma obtained before and after surgery in same patients. Comparison of lipid profiles of seminal plasma provided by patients before microsurgical varicocelectomy, who had clinical effect (n = 15) and who did not have clinical effect (n = 16), revealed differences in level of HexCer-NDS d20:0/18:0 in the positive ion test and in levels of 8 other lipids in the negative ion test. These lipids are related to the oxidation of phospholipids, cardiolipins and phosphatidylethanolamines.Conclusion. The lipid profile of seminal plasma of patients who had clinical response to varicocele surgery is significantly different from the lipid profile of seminal plasma of non-responder patients.

Predictors of Semen Parameters Decline Following the Microsurgical Varicocelectomy.

Objective Varicocele is considered the most common reversible cause of male infertility. However, some men do not clinically improve after surgical repair. We aimed to identify preoperative factors associated with decreased semen parameters and clinical "downgrading" of total motile sperm count (TMSC) following varicocelectomy. Methods We examined men with preoperative laboratory testing and pre- and postoperative semen analyses (SA) who underwent varicocelectomy between 2010 and 2020. Ejaculate volume, sperm motility, sperm concentration, TMSC, and clinical grade of TMSC (in vitro fertilization: <5M sperm, intrauterine insemination: 5-9M sperm, natural pregnancy: >9M sperm) were used to determine postoperative outcomes. Demographic and clinical factors were compared between cohorts. Results Among 101 men who underwent varicocelectomy, 35 (34.7%) had decreased postoperative TMSC with a median follow-up of 6.6 months (interquartile range 3.9-13.6 months). Eleven (10.9%) men experienced TMSC clinical "downgrading" following surgery. Clinical grade III varicocele was significantly associated with decreased sperm motility on postoperative SA (OR 4.1, 95% CI 1.7-10.0, p=0.002), and larger left testicle volume (OR 1.4, 95% CI 1.1-1.8, p=0.02) was associated with clinical "downgrading" after varicocelectomy. Conclusion A small but significant proportion of men experienced a "downgrading" of semen parameters after varicocelectomy. Larger left testis size was associated with clinical downgrading, whereas clinical grade III varicoceles were associated with lower post-treatment sperm motility. These data are critical for preoperative patient counseling.

Effect of Microsurgical Varicocele Repair on Sperm Capacitation and Probability of Generating a Pregnancy as Measured by Pre and Postoperative Novel Testing With Cap-Score

To study whether varicocele repair would improve sperm capacitation and probability of generating a pregnancy. Data were collected prospectively from 40 consecutive adult men who presented with infertility confirmed by semen analysis (SA) and found to have a varicocele on exam or ultrasound who underwent unilateral or bilateral subinguinal microscopic varicocelectomy. We recorded pre and postoperative SA, Cap-Score, and probability of generating a pregnancy (PGP) with a 3-month follow-up. Values were compared using paired t test and Wilcox rank-sum test. Results showed a 17.4% relative increase in Cap-Score (23%-27% capacitation), 25% relative increase in PGP (24%-30%), as well as statistically significant improvements in sperm concentration, motility, and total sperm count postoperatively. This study confirms that microsurgical varicocelectomy significantly improves sperm capacitation ability and improves the expected probability of generating a pregnancy within 3 rounds of intrauterine insemination. The improvement in sperm capacitation ability may help explain how varicocele repair may improve the chance of pregnancy, regardless of standard semen parameter improvements.

Results of subinguinal microsurgical varicocelectomy

The subinguinal microsurgical varicocelectomy is considered as the gold standard surgical technique for the treatment of varicocele. The objective of this study is to evaluate the results of this technique on the resolution of pain and the parameters of sperm analysis. Single-center, retrospective study that includes 22 patients who have been operated over a period of six months for a clinically palpable varicocele via the microsurgical subinguinal technique. Nine patients were operated for pain and 13 patients for infertility with an abnormality of their sperm analysis. All the patients operated for pain had a complete resolution of pain at the postoperative follow-up (3 months). Concerning the patients operated for infertility, 76.92% of the patients had a normal sperm analysis, 7.69% of the patients presented a partial improvement, and 15.39% of the patients without any improvement. Analysis of sperm's parameters at 3 months showed a significant improvement in the morphology (4.3% vs 6.69% of typical forms according to Kruger; P<0.05) and mobility (progressive mobility 15.6% vs 23% postoperatively; P<0.01). A non-significant improvement (low sample) in the concentration was noted (21.58 million/mL preoperative vs 34.9 million/mL postoperative, P=0.08). Pregnancies are noted in 38.5% of patients. A postoperative complication was noted with surgical site infection resolved with antibiotics. This single-center study confirms that the treatment of varicocele by subinguinal microsurgical route is an effective therapeutic strategy on symptomatic varicocele and in infertile men. This technique is associated with few complications.

Microsurgical Varicocelectomy: Experience of Our Sub-Subinguinal Approach and Review of the Literature

Objective. To discuss the experience with a novel surgical approach in the treatment of varicocele for fertility or pain in 772 patients. Methods. Retrospective analysis of 772 patients undergoing microsurgical sub-subinguinal (SSI) varicocelectomy in our hospital and the discussion of historical surgical approaches. Results. A total of 690 patients with left varicocele underwent surgical treatment for infertility (n = 519) and pain (n = 171). The sperm concentrations (mean ± standard deviation (SD)) of 519 patients measured preoperatively, 6 months postoperatively, and 12 months postoperatively were 19.24 ± 3.69 (106/ml), 27.42 ± 10.32 (106/ml), and 34.20 ± 16.29 (106/ml) ( ∗ ∗ P &lt; 0.01 ), respectively. The sperm motilities (mean ± SD) of 519 patients measured preoperatively, 6 months postoperatively, and 12 months postoperatively were 13.78 ± 3.25, 20.98 ± 8.21, and 27.59 ± 13.71 (grade (a + b) %) ( ∗ ∗ P &lt; 0.01 ), respectively. Pain was released surgically in 131 (76.6%) of the 171 patients. A total of 82 patients with bilateral varicocele underwent surgical treatment for infertility (n = 58) and pain (n = 24). The sperm concentrations (mean ± SD) of 58 patients measured preoperatively, 6 months postoperatively, and 12 months postoperatively were 19.21 ± 3.24 (106/ml), 27.36 ± 10.26 (106/ml), and 33.87 ± 15.20 (106/ml) ( ∗ ∗ P &lt; 0.01 ), respectively. The sperm motilities (mean ± SD) of 58 patients measured preoperatively, 6 months postoperatively, and 12 months postoperatively were 13.54 ± 2.75, 20.75 ± 8.21, and 28.53 ± 14.83 (grade (a + b) %) ( ∗ ∗ P &lt; 0.01 ), respectively. Pain was released surgically in 19 (79.2%) of the 24 patients. The probability of occurrence in one artery, two arteries, three arteries, and more than three arteries was 29.5%, 28.8%, 19.9%, and 1.9%, respectively. Conclusion. This surgical approach achieves a small and esthetic skin wound with fewer complications. The SSI approach is a safe and widely adopted surgical approach option for the treatment of varicocele.