Presence Of Varicocele Research Articles

Grade 3 Varicocele in Fertile Men: A Different Entity

Although varicocele size has an inverse relationship with baseline semen parameters and a direct relationship with seminal reactive oxygen species in infertile patients, to our knowledge the effect of varicocele grade in fertile men is unknown. We evaluated the impact of varicocele grade on seminal parameters, testicular size and seminal reactive oxygen species in fertile men. We prospectively evaluated 194 men from July 2004 to April 2010. Of the men 156 were fertile and classified by presence of varicocele. A total of 38 infertile patients with varicocele as the only identifiable cause of infertility comprised the control group. Physical examination, semen parameters and seminal reactive oxygen species were compared between the groups. Of 156 fertile men 43 (24.3%) had clinical varicocele, which was grade 1 to 3 in 22, 11 and 10, respectively. The remaining 113 men (72.7%) had no varicocele. Infertile men had smaller testes, decreased semen parameters and higher seminal reactive oxygen species than the fertile groups. Testicular size, reactive oxygen species and semen parameters did not differ between fertile men with vs without varicocele. Fertile men with varicocele grade 3 had higher seminal reactive oxygen species than those with lower grade varicocele. As varicocele grade increased, seminal reactive oxygen species increased and sperm concentration decreased. Although fertile men have more efficient defense mechanisms to protect against the consequences of varicocele on testicular function, these mechanisms may not be sufficient in those with varicocele grade 3. Further research is needed to clarify whether they are at increased risk for future infertility.

The Evaluation of Saphenofemoral Insufficiency in Primary Adult Varicocele

The aim of this study was to evaluate the possible relationship between varicocele and saphenofemoral insufficiency in patients diagnosed with primary varicocele. A total of 70 patients with the primary diagnosis of varicocele were included into the study. A total of 30 age-matched healthy adults were also included in the study as a control group. Varicocele was diagnosed by palpation and observation of each spermatic cord in standing position before and during a valsalva maneuver. Additionally, scrotal Doppler and lower extremity venous Doppler ultrasonography were performed. Patients who were with spermatic varicose vein larger than 3.0 mm were included in the study group as a varicocele patient. At the lower extremity venous Doppler ultrasonography, a retrograde flow lasting longer than 0.5 seconds during normal breathing or at the valsalva maneuver was considered to be meaningful for saphenofemoral junction insufficiency. Thirty-six (51.35%) patients had insufficiency in saphenofemoral junction in the study group (6 [8.5%] bilateral, 30 [42.85%] unilateral) whereas 8 (26.6%) had insufficiency in the control group (2 [6.6%] bilateral, 6 [20%] unilateral insufficiency). The patients with primary varicocele had a statistically significant (P = .02) higher rate of venous insufficiency in their saphenofemoral junctions when compared with the control group. In the present study, the rate of saphenofemoral insufficiency has been found to be statistically higher in patients with primary varicocele compared with healthy men. Depending on the common presence of valvular insufficiency, we believe that the presence of varicocele should be investigated in the young population suffering from saphenofemoral junction insufficiency.

Contemporary concepts in the evaluation and management of male infertility.

Infertility in men is a common condition. At the core of the medical evaluation of the male partner in a couple who are unable to conceive is the history and physical examination. Special attention should be directed to the patient's developmental history and any use of testosterone products. The physical examination focuses on the genitals, and includes assessments of the size and consistency of the testicles, epididymis, vas deferens, and presence of varicoceles. Although many sophisticated tests are available, semen analysis is still the most important diagnostic tool used to assess fertility, and includes parameters such as sperm count, motility and viability. Treatment of male factor infertility can involve targeted agents, in the case of specific conditions such as hypogonadotropic hypogonadism, or it can be empirical-using medical therapy or assisted conception techniques-for patients in whom no underlying cause has been identified. Although an all-encompassing treatment for male factor infertility has not yet been developed, the field offers many promising avenues of research.

Nationwide survey to evaluate the prevalence of varicoceles in South Korean middle school boys: A population based study

We carried out a nationwide epidemiological study to evaluate the prevalence and effect of varicoceles on testicular volume in South Korean adolescents. We also investigated the correlation between varicoceles and body mass index (BMI). In this prospective study, physical examinations were carried out to assess the presence and severity of varicoceles in middle school boys from six regions of South Korea. Testicular volume, height and weight of all boys were measured. The prevalence of varicoceles was assessed. The associations between age, testicular volume, BMI, and the presence and severity of varicoceles were examined. A total of 1938 boys with a mean age of 14.1 years (range 13-16 years) were screened. A varicocele was found on the left side in 295 (15.2%) boys and on the right side in 8 (0.4%) boys. Bilateral varicoceles were found in 17 (0.9%) individuals. Of the subjects with a left varicocele, 151 (51.2%), 80 (27.1%) and 64 (25.1%) boys had a grade 1, 2 or 3 varicocele, respectively. The prevalence of varicoceles did not increase with age. The proportion of boys with testicular size discrepancies increased with the severity of the varicocele. After adjusting for age, BMI had a negative correlation with the presence of varicoceles. The prevalence of varicoceles in South Korean middle school boys is 16.5%. The presence of varicoceles seems to have a negative effect on testicular growth. BMI has a significant inverse relationship with the occurrence of varicoceles.

Heat Shock Protein and Heat Shock Factor Expression in Sperm: Relation to Oligozoospermia and Varicocele

Varicocele may be associated with normozoospermia or oligozoospermia. Much controversy still exists regarding the diagnosis, management and pathophysiology of spermatogenesis alterations associated with varicocele. The increased temperature induced by varicocele and stress in general may activate heat shock proteins and heat shock factors with a protective function in cells. We analyzed the expression of 5 heat shock proteins and heat shock factors in the sperm of men with normozoospermia and oligozoospermia with or without varicocele. We performed a prospective study between June 2008 and February 2009 at an academic clinic in 117 consecutive patients with varicocele and 68 controls without varicocele. Four groups were based on the presence/absence of varicocele and normozoospermia/oligozoospermia. Subjects were studied by history, physical examination, scrotal Doppler ultrasound, semen analysis, reproductive hormone plasma levels and quantitative real-time polymerase chain reaction in RNA extracted from ejaculated sperm to analyze HSP90, HSPA4, HSF1, HSF2 and HSFY expression. Increased HSPA4, HSF1 and HSF2 were observed in the sperm of men with varicocele and in those with oligozoospermia. Levels were maximum when the 2 conditions were present. Increased HSP90 was observed in oligozoospermia cases independent of varicocele. HSFY was up-regulated only in patients with varicocele, especially those with normozoospermia. To our knowledge we describe for the first time the expression of different heat shock proteins and heat shock factors in ejaculated sperm. While some of these proteins are up-regulated in men with oligozoospermia and varicocele, HSFY is up-regulated only in the presence of varicocele and especially in men with normozoospermia. This suggests that it may be a molecular marker of an adequate or inadequate response to the damaging effect of varicocele on spermatogenesis.

Body mass index vis-à-vis total sperm count in attendees of a single andrology clinic

In this large series of 349 unselected men, no significant relationship between body mass index and total sperm count was found. Thus, the association of body mass index and sperm count reported in some studies was not confirmed.

Report on varicocele and infertility

Controversies regarding diagnosis and treatment of varicoceles in male partners in infertile couples are considered in detail.

Does a clinical varicocele influence the relationship between testicular volume by ultrasound and testicular function in patients with infertility?

To determine whether varicocele influences the testicular volume-function relationship. Retrospective clinical study. University hospital. One hundred fifty infertile patients with varicocele and 299 without varicocele. Semen analyses, scrotal ultrasound, and serum FSH, LH, and T levels. The mean testicular volume was measured by ultrasound. To evaluate the testicular volume-function relationship in infertile patients with varicocele and in those without varicocele, the patients were divided into seven and 10 groups, respectively, according to the mean testicular volume. The semen density, total sperm count, and serum FSH levels significantly correlated with the mean testicular volume in both patient groups, but patients without varicocele had a greater correlation coefficient than those with varicocele. The mean testicular volume with mean sperm densities indicating oligozoospermia was greater in the patients with varicocele than in patients without varicocele (12.5 and 10.0 mL, respectively). The mean testicular volume with mean FSH concentration exceeding the normal range was higher in patients with varicocele (15.0 mL) than in patients without varicocele (12.5 mL). The testicular volume-function correlation differed between patients with varicocele and those without varicocele. The presence of varicocele therefore influences the relationship between the testicular volume and the testicular function.

Reply to Letter to the Editor: V. Iaccharino. A Proposed Anatomical Typing of the Right Internal Spermatic Vein: Importance for Percutaneous Sclerotherapy of Varicocele (CVIR 30[2]:347, 2007)

We commend Dr. Iaccarino on his extensive experience with treating varicocele. We agree that sclerotherapy is the most effective way of treating the main internal spermatic vein (ISV) and assuring that the ever-present collaterals are also sclerosed, reducing recurrences. Retrograde (transcatheter) transfemoral sclerotherapy in experienced hands is both safe and efficacious, with none of the theoretical complications suggested by Dr. Iaccarino. We do not heparinize our patients, who are mobilized within 30 min of the completion of their treatment and told not to lie in bed after the first 4 h. We have seen no cases of clinical symptoms of thromboembolism, either systemic or portal. (We are somewhat surprised at such a case: Does Dr. Iaccarino have one?) It might be expected in esophageal varices sclerotherapy, but the amounts of sclerosant that we use and the sclerosing characteristics of 3% sodium tetradecyl sulfate are such that this is not a consideration. We disagree with Dr. Iaccarino about the treatment of so-called subclinical varicocele. We have shown in several of our articles that the physical (hydrodynamic) principles which explain the pathophysiology of varicocele require only that there be incompetent ISV valves for the abnormally high venous pressures to be directly transmitted to the testicular microcirculation and interfere with normal perfusion of the testicular parenchyma. The result is hypoxia of the testicular tissue and this has been shown on histopathology of varicocele (also cited in our articles in the References section of our original paper: CVIR, Vol. 29, No. 2, 192– 197, 2006). The presence of varicocele on the right cannot be reliably demonstrated clinically by Valsalva maneuver because of the hydrodynamics of the right ISV: specifically, its direct emptying into the inferior vena cava (IVC). It is not possible to adequately distend the IVC during Valsalva and elevate pressures for a prolonged time without nearly arresting venous return to the heart and causing very rapid syncope. At the same time, the angle between the ISV and the IVC is acute, and the changes in the relationship between these two venous structures during Valsalva maneuver act to close that angle and decrease flow. Only in those patients with direct emptying of the right ISV into the right renal vein (about 8% in our study), in which the configuration nearly mirrors the left anatomy, can this maneuver be relied on to result in reflux. And again, reflux does not have to be massive (as Dr. Iaccarino proposes) for it to cause infertility. We have (as have others using microsurgical techniques) shown a small but significant group of responders to bilateral sclerotherapy in patients with Sertoli cell only. Dr. Iaccarino cites Dr. Nagler’s comments in the Journal of Urology (2004), in which he questions whether treatment is at all effective. This is in keeping with the multicenter study which showed poor results for ISV occlusions—surgical and interventional techniques. Our response to Dr. Nagler was that we agree that the treatment of varicocele as described by the various authorities was not effective (more than medical treatment), but not because varicocele does not affect fertility: rather, because the treatments were essentially inadequate, ignoring the physical basis for the pathophysiology and the presence of significant venous reflux on the right, not just by interscrotal collaterals. M. Gornish (&) Y. Gat Y. Siegel Department of Radiology, Maayanei Hayeshua Medical Center, Bnei Brak, Israel e-mail: menachemg@skynet.co.il

Serum inhibin B concentration as a prognostic factor for prediction of sperm retrieval in testis biopsy of patients with azoospermia.

This study was conducted to determine if serum inhibin B concentration can predict spermatogenesis in azoospermic infertile men. This cross-sectional study included 70 patients with male-factor infertility referred to Alvand and Vali-e-Asr Infertility Centers, Tehran, Iran. All patients had azoospermia. Standard evaluation consisted of history and physical examination with extreme attention to sexual history and testis examination including testis size, consistency, and presence of varicocele. Laboratory evaluation done for all cases consisted of FSH, testosterone, LH, prolactin, and inhibin B. Testis biopsy was performed in all cases with acceptable testis volume and FSH. The mean inhibin B level was compared in groups with positive and negative sperm retrieval. The mean+/-SEM age of 70 azoospermic patients was 32.1+/-6.2 (range: 20 - 50) years. All couples had primary infertility with a mean+/-SEM duration of infertility of 74.3+/-7.7 months. The mean+/-SEM testicular volume was 10.14+/-0.75 mL. The mean+/-SEM FSH and LH levels were 17.55+/-1.68, and 11.33+/-0.99 mIU/mL, respectively. The mean+/-SEM serum prolactin and testosterone levels were 308.77+/-17.35 and 5.45+/-0.91 ng/dL, respectively. The mean+/-SEM serum inhibin B concentration was 138.23+/-28.58 (range: 15 - 1500) pg/mL. Sperm was not retrieved in 82% of the patients; in 13% of the cases, biopsy revealed spermatogenesis. The mean+/-SEM serum FSH level of positive and negative groups was 9.78+/-2.13 and 22.56+/-2.46 mIU/mL, respectively (P<0.05). The mean serum LH, prolactin, and testosterone levels were not statistically different between the two groups. The mean+/-SEM serum inhibin B was 129+/-45.46, and 158.93+/-47.24 pg/mL in positive and negative groups, respectively (P>0.05). Inhibin B concentration is not an appropriate predicting factor for testicular spermatogenesis.

Improvement in serum testosterone levels after varicocelectomy

A growing body of evidence suggests that presence of varicocele impairs Leydig cell function, with a resultant decrease in testosterone (T) production. Men with varicocele(s) may, therefore, be at risk for androgen deficiency. This investigation was undertaken to define if men with varicocele and low testosterone levels experience an increase in T levels following microsurgical ligation surgery.

Sperm selection by swim-up in terms of deoxyribonucleic acid fragmentation as measured by the sperm chromatin dispersion test is altered in heavy smokers

Toxic habits and their relationship with male factor infertility have been a matter of investigation in recent years, and smoking is one of the most common lifestyle toxic exposures to harmful substances. The analysis of sperm deoxyribonucleic acid fragmentation after capacitation detected a detrimental effect produced by tobacco, and this deleterious effect alters the sperm swim-up selection process in smokers, although the molecular and cellular basis of this phenomenon remain to be elucidated.

Paternity After Varicocelectomy

This study was done to assess the sonographic findings that could predict the outcome of varicocele repair in the treatment of male infertility/subfertility related to varicocele. This was a retrospective study and follow-up of 107 selected patients with male factor infertility related to the presence of varicocele. The patients were classified into 2 groups according to their estimated testicular size by sonography. Group 1 included 80 patients with normal-sized testes (>15 cm(3)), and group 2 included 27 patients with small testes (10-15 cm(3)). The mean age +/- SD was 34 +/- 11 years. The mean duration of infertility was 3.4 +/- 1.4 years. They had oligospermia, asthenospermia, or oligoasthenospermia. The patients underwent low ligation varicocelectomy and were followed for 18 to 45 months after surgery for occurrence of paternity. Their scrotal sonographic findings were reviewed and correlated with the postoperative paternity rate. Postoperative paternity was achieved in 24 patients (30%) of group 1 with normal-sized testes and in 3 patients (11%) of group 2 with small testes. In patients of group 1, the positive paternity rate was higher (36.6%) in patients with clinically detected varicocele, compared with only 16% of patients with subclinical varicocele. In addition, postoperative paternity was significantly higher in patients with bilateral varicocele (54.5%; P = .0099), patients with shunt-type varicocele (75%; P = .0117), and patients with a permanent grade of venous reflux (70%; P = .0148). No significant differences were noted between positive paternity rates in patients with mildly or markedly dilated veins. The best preoperative sonographic parameters of success of varicocele repair are the presence of normal-sized testes, clinically palpable veins, bilateral varicocele, shunt-type varicocele, and a permanent grade of venous reflux. It does not matter how much the veins are dilated.

The Relationship Between Varicoceles and Obesity

To determine if a relationship between weight and varicocele occurrence exists, the prevalence of varicoceles was determined in a population of patients presenting with infertility. Records of 3,213 males presenting with infertility were examined. Patients underwent physical examinations for varicocele presence and grade. Body mass index was calculated. Patients were categorized as normal weight, overweight and obese using National Institutes of Health criteria. Means were compared with Student's t test. Frequencies were compared by chi-square analysis and statistical significance was considered at p < 0.05. A total of 1,093 (34%) patients had varicoceles. The mean body mass index of those without varicoceles was 28.5 (+/- 5.6) kg/cm2, which was greater than the body mass index of those with varicoceles (26.7 [+/- 4.0] kg/cm2) (p < 0.001). Varicocele frequency was calculated for each body mass index group. In the normal weight group (body mass index less than 25) 378 of 884 patients (43%) had varicoceles. In the overweight group (body mass index 25 to less than 30) 540 of 1,549 patients (35%) had varicoceles. In the obese group (body mass index 30 or greater) 175 of 780 patients (22%) had varicoceles (p < 0.001). Analysis comparing varicocele frequency based on varicocele grade per body mass index group was performed. Prevalence of varicocele decreased with increasing body mass index for all varicocele grades (p < 0.001). Prevalence of varicocele decreases with increasing body mass index. One explanation is increased adipose tissue preventing compression of the left renal vein. Another explanation is decreased detection due to adipose tissue in the spermatic cord. The decrease in varicocele prevalence as a function of body mass index regardless of varicocele grade suggests this explanation is less likely.

Evaluation of varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography: A new etiological factor for varicocele?

Purpose To evaluate the varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography. Materials and methods Sixty patients {48 patients with upper motor neuron injury (U-MNI) and 12 patients with lower-MNI} with traumatic spinal cord injury and age matched 48 healthy volunteers were enrolled in this prospective study. Testis volumes and varicocele grades were determined. Presence of varicocele was also classified according to clinical significance. Results Testis volumes of U-MNI sub-group (14.81 ± 4.74 ml) were significantly smaller than the control group (18.20 ± 4.52 ml, p = 0.000) and L-MNI sub-group (17.88 ± 3.23 ml, p = 0.008). No left-sided clinical varicocele was found in L-MNI sub-group (0/12, 0%), whereas there were 14 patients in control group (14/48, 29%) and 7 patients in U-MNI sub-group (7/47, 15%), and the difference was statistically significant ( p = 0.000, 0.007, respectively). Conclusion Clinical varicocele frequency of U-MNI patients, who have spastic paralysis of abdominal and lower extremity muscles, is similar to the control group. This finding inspires that increased intra-abdominal pressure via normal to increased abdominal muscle tonus may have a role in the varicocele etiology, beside the classical factors. Absence of clinical varicocele in L-MNI patients, who have flaccid paralysis of the same muscle groups, supports this observation.

Increased prevalence of varicocele in patients with coronary artery ectasia

Coronary artery ectasia (CAE) is defined as localized or diffuse non-obstructive lesions of the epicardial coronary arteries with a luminal dilation exceeding the 1.5-fold of normal adjacent segment or vessel diameter. Varicocele is the dilatation of the pampiniform plexus. Recently increased prevalence of peripheral varicose veins has been shown in patients with CAE. In this study we aimed to assess the prevalence of varicocele, which is dilatation of another venous system, in patients with CAE. Thirty-five male consecutive patients with coronary artery ectasia in combination with or without coronary artery disease (CAD) and 63 male, age-matched patients with coronary artery disease were included in the study. All patients were evaluated for the presence of varicocele. Twenty-one patients with CAE were found to have varicocele (62% of group I patients). In patients with CAD, 24 patients (38%) were found to have varicocele. The difference between the two groups in respect to presence of varicocele was statistically significant (P=0.02; odds ratio=1.57; 95% confidence interval 1.05- 2.3). We have shown that patients with coronary artery ectasia have an increased prevalence of varicocele compared to those with coronary artery disease. The mechanism underlying coronary artery ectasia might further increase the prevalence of varicocele in susceptible patients.

Inheritance of varicoceles

Objectives To evaluate the inheritance of varicoceles through examination of first-degree relatives of patients with known varicoceles. Methods A total of 44 patients with a known varicocele had available first-degree relatives (n = 62) examined for the presence of a varicocele between October 1997 and November 2003. An additional cohort of 263 men presenting for vasectomy reversal without a history of subfertility or varicocele was used as the control group. Varicocele grade and the presence of bilateral varicoceles were examined as predictive factors for inheritance. Results Of the 62 first-degree relatives of patients with a known varicocele, 35 (56.5%) had a clinically palpable varicocele on physical examination. This was significantly greater than the 18 (6.8%) of 263 men in the control group ( P <0.0001). Of the first-degree relatives, 20 (74%) of 27 brothers, 13 (41%) of 32 fathers, and 2 (67%) of 3 sons had palpable varicoceles. Neither varicocele grade nor bilaterality was predictive of inheritance in these first-degree relatives. Conclusions The increase in varicocele prevalence is significant in the first-degree relatives (particularly brothers) of patients with known varicoceles. Given the detrimental effect of varicoceles on spermatogenesis and steroidogenesis, patients should be counseled about this increased risk in male family members.

Incidence of retro-aortic left renal vein and its relationship with varicocele

The retro-aortic left renal vein (RLRV) is a malformation characterized by the presence of a vessel that drains the left renal blood up to the inferior vena cava crossing behind the aortic artery. Varicocele is defined as venous dilation of the pampiniform plexus, and the left side is the most commonly affected. Several theories concerning the possible aetiology of varicocele are reviewed in the literature, but RLRV was not mentioned as an aetiologic factor of varicocele. in this study we investigated the percentage of RLRVs and their relation with varicocele. A total of 1,125 contrast-enhanced abdominal CT scans was examined to identify RLRVs. RLRVs were found in nine women (1.6%) and ten men (1.7%). We performed scrotal Doppler ultrasonography (US) for all affected men except one. Varicocele of varying degrees was found in seven of the nine male patients with RLRV (77%). RLRV could be one of the aetiological factors in the development of varicocele, and the cases with RLRV should be examined by scrotal Doppler US for the presence of varicocele.

Intratesticular arterial resistance and testicular volume in infertile men with subclinical varicocele

The aim of this study was to evaluate whether intratesticular arterial resistance and testicular volume differed between infertile men with subclinical varicoceles and infertile men without varicoceles. Fifty-eight infertile men were examined by gray-scale and color Doppler sonography for presence of varicocele, testicular volume, and arterial resistance. For men in the study group, mean testicular volume and resistance index (RI) in testes with varicoceles were compared with those in the contralateral testis by the paired t-test; statistical analyses between the study and control groups were performed by independent t-tests. Twenty-seven men had left-sided varicoceles (96% of which were subclinical), and 31 infertile men without varicoceles served as controls. Mean volumes of the right and left testes of study subjects were 14.8 ml and 14.6 ml, respectively, and in controls were 14.2 ml and 13.6 ml, respectively. Mean RI values for the right and left testes of study subjects were 0.61 and 0.58, respectively, and in controls were 0.61 and 0.58, respectively. There were no statistically significant differences in volume or RI, either between the right and left testes within patient groups or between the control and study groups' combined mean values. While the mean intertesticular volume differences for the study and control groups were 2.2 ml and 3.4 ml, respectively, the mean intertesticular RI differences were 0.04 and 0.07, respectively. These values also did not differ significantly between the 2 groups. Subclinical varicocele is not associated with ipsilateral testicular atrophy, and does not affect the intratesticular arterial RI.

Size matters in nonobstructive azoospermic men − Model to predict sperm at testicular sperm extraction

Testicular sperm extraction (TESE) is performed in men with non-obstructive azoospermia or severe oligospermia considering assisted reproductive techniques (ARTs). Patients make a significant financial/emotional commitment, but are not always successful. Our goal was to design a model to preoperatively predict if sperm would be found. Retrospective review of 45 patients (57 cases) with non-obstructive azoospermia by a single surgeon (AJT) from May 1999 to February 2004 (each testicle considered a separate case for analysis) for model design. Testing of the model on 21 patients at two separate institutions for external validation. On retrospective review, sperm was found in 44.4% of the patients (23 cases-20 patients). Selection was based on chart availability (only patients with preoperative lab testing and imaging at our institution were included). Patient age, testicular size (caliper measurement/ ultrasound), preoperative FSH, testosterone levels, semen analysis within three months (volume, pH), presence of microlithiasis (by ultrasound), presence of varicocele (ipsilateral and/or contra-lateral) and final operative findings (sperm found or not) were recorded. Univariate logistic regression analysis of these parameters revealed that testicular size (caliper measurement/ ultrasound) and pre-biopsy seminal pH were significant predictors of finding sperm at the time of surgery. On multivariate analysis, seminal pH was an independent predictor of finding sperm. We then designed a linear scoring algorithm based on the above significant parameters to predict if sperm would be found. The model was then tested on 21 patients (24 cases) at two separate institutions for external validation. Model prediction accuracy was 73.7% in the design group. The area under the ROC curve for the model was 0.7. Model accuracy was 80% (10 patients) and 64.3% (11 patients) in the test groups at the separate institutions. Palm™ and Windows™ versions of the model may be downloaded as free shareware from: www.uroengineering.com. Our model provides a preoperative prediction as to the outcome from TESE with an accuracy of 64.3% to 80%. This may allow for preoperative counseling of patients. This model can be accessed by any physician and tested at different institutions for further model refinement.