Microsurgical Subinguinal Varicocelectomy Research Articles

P-061 Effect of Varicocelectomy on fertility potential and pregnancy outcome: results of a large cohort from a tertiary medical center

Abstract Study question Does varicocelectomy improve semen parameters, hormones & pregnancy outcomes in infertile men with clinical varicocele? Summary answer In infertile men with clinical varicocele, sperm count, motility, and DNA fragmentation improved significantly after varicocelectomy. Pregnancy outcomes improved for both spontaneous and assisted reproduction. What is known already Infertility is estimated to impact 15% of couples attempting to conceive worldwide. Varicocele has been identified as the most common surgically correctable cause of male infertility. Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters & pregnancy outcomes remains controversial. Few systematic reviews and meta-analyses (SRMAs) evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach with fewer studies reporting on pregnancy outcomes. Study design, size, duration This was a retrospective study of 2171 patients presenting with infertility & clinical varicocele between 2014 and 2024. Participants/materials, setting, methods Exclusion criteria were prior medications, medical illnesses causing infertility, or endocrine disorders. All participants underwent sub-inguinal microsurgical varicocelectomy. Data regarding patient demographics, clinical findings, semen analysis, serum hormone levels & pregnancy outcomes were collected pre and post-operatively. Variables were examined before & after varicocelectomy. X2 test and Kruskal-Wallis test were used to analyze categorical and numerical values, respectively. A p value < 0.05 was considered statically significant. Main results and the role of chance A 2171 participants were included. The mean age ± SD of the study population was 33.65 ± 8.54 years. Their mean right testicular size, left testicular size, right vein size, and left vein size were 14.38 ± 4.56,13.46 ± 3.49, 2.47±0.79 & 3.99 ±1.33 respectively. When subdividing them by grade of varicocele, on the right side, grades 1, 2, and 3 were detected in 692 (31.9%), 491 (22.6%), and 63 (2.9%), respectively. While on the left side, grades 1, 2, and 3 varicoceles were detected in 303 (13.9%), 999 (46%) & 867 (39.9%), respectively. Indication for surgery was pain (37%, primary infertility (42.9%), secondary infertility (18.3%), and others (3.6%). The majority performed unilateral varicocelectomy (1776 {81.8%}), while 396 (18.2%) underwent bilateral varicocelectomy. Varicocelectomy significantly improved sperm count, total & progressive motility & DNA fragmentation. Pregnancy outcomes improved postoperatively for both spontaneous (32.3%) & assisted reproduction (25.2%). No significant change was found in hormones postoperatively. Limitations, reasons for caution Retrospective study, single center experience. Wider implications of the findings It is important in patients’ counselling & choose the best management for this group of patients. Trial registration number NA

P-063 Effect of varicocelectomy on serum testosterone levels of hypogonadal men above 40 years of age

Abstract Study question Can varicocelectomy be indicated for the treatment of hypogonadism in men above 40 years of age? Summary answer Varicocelectomy improves serum testosterone (T) levels in men with preoperative hypogonadism. This improvement can be anticipated in men above the age of 40 years. What is known already Varicocele ligation is a common intervention used to restore male fertility potential and enhance conception rates. Few studies reported a favorable effect for varicocelectomy on serum T levels stirring some scientists to indicate treatment for men with late onset hypogonadism. Nonetheless, data is still scarce for such a recommendation highlighting the importance of this work Study design, size, duration The charts of 1696 patients who underwent microsurgical subinguinal varicocelectomy for clinically palpable disease between 2011-2023 were retrospectively reviewed. Patients with available pre- and post-operative serum hormone levels were included in the study while those receiving any form of androgen replacement or induction treatment or with known secondary causes of hypogonadism were excluded. Participants/materials, setting, methods Medical charts were reviewed to collect demographic and clinical data. Patients were classified into 2 groups according to preoperative T levels: hypogonadism group (serum T < 10.4 nmol/L) (n = 226) and eugonadal group (serum T ≥ 10.4 nmol/L) (n = 1469). The hypogonadism group was subclassified according to age into less (n = 161) or ≥ (n=66) 40 years of age. Changes in hormone levels were analyzed using Wilcoxon Signed Ranked. A p value <0.05 was considered significant. Main results and the role of chance The patients mean age was 33.6 ± 8.5 years. Their mean BMI was 27.2 ± 5.8 Kg/m2, mean left testis size was 13.4 ± 3.5 cm3 and right testis size 14.4 ± 4.5 cm3. The maximum left and right vein diameters was 3.9 ± 1.3 mm and 2.46 ± 0.73 mm. Unilateral and bilateral microsurgical varicocelectomy were performed in 82% and 18% of cases, respectively. Post-operatively, no significant changes were observed in hormone levels in comparison to preoperative values in the eugonadal group. However, patients with preoperative hypogonadism had significant increase in serum T (7.7±2.2 vs 11.7±6.6, p < 0.001) and E2 (72.5±31.3 vs 94.8±42, p < 0.001) levels following the intervention. These significant improvements were observed in both men < 40 years of age (p < 0.001 for both T and E2) and ≥ 40 years of age (T: p = 0.027, E2: p = 0.024). Limitations, reasons for caution Results were obtained from a retrospective chart review. The majority of these patients performed surgery for fertility reasons and data regarding hypogonadism symptoms is lacking. Wider implications of the findings Results of this study further confirm that an increase in serum testosterone is likely to be anticipated in patients undergoing varicocelectomy who have low serum testosterone levels pre-operatively Trial registration number not applicable

P-064 Adolescent varicocele: clinical profile and impact of treatment

Abstract Study question What is the clinical presentation of adolescent varicocele and the impact of its repair on semen quality? Summary answer Adolescent varicocele usually presents as testicular pain and does not influence semen quality. Varicocele ligation does not impact postoperative semen results in this patient population. What is known already Varicocele is a common condition characterized by the abnormal dilation of the pampiniform plexus of veins resulting in testicular dysfunction and impaired semen quality. While the effect of varicocelectomy on the fertility potential of adult men has been commonly explored, its impact on semen parameters of adolescents is less commonly investigated. Study design, size, duration The charts of 2171 patients who underwent microsurgical subinguinal varicocelectomy for clinically palpable disease between 2011-2023 were retrospectively reviewed. Patients <19 years of age were included in the analysis. Participants/materials, setting, methods The patients’ medical charts were reviewed to include demographic and clinical characteristics; indication of surgery, body mass index, testis size, grade of clinical disease, vein diameter (assessed with scrotal ultrasound) and semen analysis results (WHO 2010). Data were analyzed using Wilcoxon Signed Ranked. Mean ± SD and median (IQR) were used to report normally and non-normally distributed data, respectively. A p value <0.05 was considered significant. Main results and the role of chance A total of 94 adolescent patients were included in the study. Their mean BMI was 22.14±5 Kg/m2, mean left testis size was 12.26 ± 3.05 cm3 and right testis size 13.26±3.94 cm3. The maximum vein diameter 4.7±1.04 mm and right vein diameter 2.21±0.83 mm. 83 patients underwent unilateral Microsurgical Varicocelectomy while 5 patients underwent bilateral Microsurgical Varicocelectomy. Left varicocele was of grades 3, 2 and 1 in 65, 18 and 11 patients, respectively. Surgery was indicated for testis size discrepancy in 36.2% of cases and on elective basis (prior to army recruitment) in 63.8% of cases. Table 1 presents the pre- and post-operative semen parameter results. Patients had normal pre-operative medians of sperm count, total motility and normal morphology. No significant post-operative changes were observed in the semen quality of adolescents. Limitations, reasons for caution Results were obtained from a relatively small sample size. However, varicocele is less commonly performed on adolescents necessitating further studies on this patient population. Wider implications of the findings Results of this study shed the light on the characteristics of adolescents presenting with varicocele. Trial registration number NA

(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.

(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.

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.

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.

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.

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.

P-026 Effect of Microsurgical Varicocele Ligation in Patients with Isolated Oligozoospermia

Abstract Study question Is varicocelectomy effective in improving the semen quality of patients with isolated oligozoospermia (IO)? Summary answer Varicocelectomy is a valid option for infertile men with clinical varicocele and documented IO considering the significant improvement in semen concentration. What is known already Varicocele is the leading correctable cause of male factor infertility and its surgical treatment has been associated with sound improvement in semen quality and fertility potential. While varicocelectomy is clearly indicated in men with abnormal semen parameters, its effect on men with isolated abnormalities is less commonly assessed. Study design, size, duration The charts of 1521 patients who underwent microsurgical subinguinal varicocelectomy for clinically palpable varicocele between 2011-2021 were retrospectively reviewed. Infertile patients with IO were included in the study group, while data from patients with oligoasthenoteratozoospermia (OAT) were utilized for comparison. Participants/materials, setting, methods Men with azoospermia, a history of genitourinary infection, and those utilizing peri-operative fertility medications were excluded. The collected data included patient's demographics, varicocele grade and veins’ sizes, and their semen (semen analysis, WHO 2010; sperm DNA fragmentation, Halosperm) and hormone parameters before and up to 6 months after varicocelectomy. Data were analyzed using Wilcoxon Signed Ranks test and chi-squared tests. A p value &amp;lt;0.05 was considered significant. Main results and the role of chance A total of 96 patients with IO and 123 patients with OAT were included in the study. Patients with IO had a mean age of 32.5 ± 7 years, and an average testis volume of 15.6ml. The varicocele was of grades 2 and 3 in 58% and 38% of patients. Among the IO group, a significant increase in sperm concentration was identified postoperatively (p = 0.01). Surprisingly, results revealed a significant decrease in sperm total motility, however, the postoperative median was still within the normal range (45.5%). No significant changes were observed in other semen or hormone parameters. When a comparison was made with the OAT group, 83% of patients with IO had an improvement in sperm concentration compared to 63.9% of patients in OAT group following varicocelectomy (P = 0.044). However, a higher percentage of patients showed an improvement in total motility among the OAT group (67.6%) in comparison to the IO group (42.9%) (p = 0.04). Limitations, reasons for caution Results were obtained from a relatively small sample size. However, varicocele treatment is not necessarily considered as the first treatment option in men with mild or isolated derangements in semen quality. Wider implications of the findings Results of this study shed the light on the effect of varicocele treatment in men with isolated oligozoospermia and hence may be beneficial for patient counselling in the clinic. Trial registration number not applicable

Microsurgical subinguinal varicocelectomy in children and adolescents. Modified technique with lymphatic vessel contrast enhancement

Microsurgical subinguinal varicocelectomy in children and adolescents. Modified technique with lymphatic vessel contrast enhancement

Varicocele – impact on fertility and results of various methods of surgical treatment

Introduction: Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. In this article we reviewed the epidemiology, symptoms, and various surgical techniques for the treatment of varicoceles and the results of following treatment.Material and methods: The work was based on medical articles collected in PubMed, websites and medical books. The research was conducted by looking at keywords such as: "Varicoceles", "varicocelectomy" and “infertility”. Results: There are many methods of treating varicoceles ranging from Microsurgical subinguinal varicocelectomy (MSV) or Laparoscopic varicocelectomy. Conclusions: The interdisciplinary approach to the patient and innovative surgical techniques can provide us with many solutions in the treatment of the disease. Doctors should adjust treatment to provide the best therapeutic effects.

Changes in testicular arterial hemodynamic, gonadotropin levels, and semen parameters among varicocele patients randomized to varicocelectomy or observed in Tamale, Ghana.

A randomized trial to compared testicular blood flow parameters, gonadal hormones, and semen characteristics among three groups; surgery group (n = 127); observed group (n = 114); and healthy controls (n = 33). The blood flow parameter selected was resistive index (RI) measured using color Doppler ultrasonography. Serum total testosterone, FSH, LH were measured, and semen analysis performed at baseline and repeated 12 months of follow-up. The data was computed using GraphPad Prism (v8.0) at an alpha of 0.05. In the observed group, increased +0.0060 in the right (R_RI) and in the left (L_RI) +0.0026 capsular arteries from baseline measurement to 12 months follow-up. Surgery group, reduced -0.079 in the right (R_RI) and -0.0731 in the left (L_RI) capsular arteries (p < 0.0001). At 12 months, the changes for both left and right RIcap in the surgery group did not reach the values of the controls. In the surgery group, L_RIcap (r = -0.63; p < 0.0001) and R_RIcap (r = -0.49; p = 0.004) correlated with total testosterone, FSH (r = 0.57; p = 0.001 for left; r = 0.52; p = 0.002 for right), and LH (r = 0.61; p = 0.0002 for left; r = 0.41; p = 0.020 for right). Furthermore, L_RIcap correlated with changes in sperm count (r = -0.46; p = 0.008) and sperm concentration (r = -0.35; p = 0.011) in the surgery group. Microsurgical sub-inguinal varicocelectomy improves blood supply to the testicular tissues evidenced by reduced resistive index in the surgery group. Resistive index in the left capsular artery can be used to evaluate the success of surgery because it correlates with total testosterone, FSH, LH, and semen quality.

Effect of redo varicocelectomy on semen parameters and pregnancy outcome: An original report and meta‐analysis

Recurrence following varicocelectomy is an important cause of treatment failure and persistence of subnormal semen parameters. This original study was combined with a systemic review and meta-analysis aiming to evaluate the efficacy of redo varicocelectomy on male fertility potential and pregnancy outcome. The retrospective study included 32 patients who underwent microsurgical subinguinal varicocelectomy for patients with recurrent varicocele. Changes in semen parameters and hormone profiles before and after surgery were compared. The literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and included seven articles in addition to our original report. Results of the original study revealed statistically significant improvements in sperm concentration, progressive motility, total motile sperm count and normal morphology following redo varicocelectomy. The meta-analysis results echoed those reported in our original study and depicted significant improvements in sperm concentration (mean difference [MD]=+20.281 million/ml, p< 0.001), total motility (MD=+9.659%, p= 0.001), total motile sperm count (MD=+23.258 million sperm, p< 0.001) and normal morphology (MD=+4.460%, p< 0.001). Overall pregnancy outcome was reported in seven studies with a rate of 34.6%. No significant changes were noted in any of the collected hormone results both in this original report and in the meta-analysis. In conclusion, redo varicocelectomy has a beneficial role on male fertility potential and can be offered for men with recurrent varicocele as directed by their individual clinical condition.

Clinical efficacy comparison of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in primary varicocele patients.

Varicocele is a more common male genitourinary system disease with sperm quality dysfunction or discomfort. This study was aimed to compare the clinical efficacy of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in treating primary varicocele. Total of 59 patients with primary varicocele receiving a 3-month postoperative follow-up were included to analyse their biochemical parameters and clinical outcomes, including the operative time, hospitalization time, postoperative recurrence rates, and complication rate. Nineteen patients were treated with sclerosing embolization with 3% polidocanol (SE group), while 40 patients were treated with microsurgical subinguinal varicocelectomy (MSV group). For the SE group, 17 patients were treated on the left side, and two patients have treated on both without recurrences and complications during the follow-up period. For the MSV group, three patients were treated bilaterally, and 36 patients were treated separately on the left side with a total 5% recurrence rate and 10% complication rate. The duration of surgery and the hospitalization time of the SE group (46.2 ± 9.79 min and 2.53 ± 0.90 days, respectively) are significantly lower than MSV group (100.5 ± 13.76 min and 3.6 ± 1.58 days, respectively), p < 0.05. The total sperm count at 3months was significantly higher in the SE group than in the MSV group (p < 0.05). In summary, sclerosing embolization is more effective for varicocele in improving sperm quality, shortening recovery time, and reducing recurrence rates and complications.

P-040 Impact of varicocele on male fertility potential: comparison of unilateral vs bilateral disease on clinical presentation and outcome of varicocelectomy

Abstract Study question Is there a difference between unilateral and bilateral varicocele on clinical presentation and postsurgical outcome of infertile men undergoing microsurgical subinguinal varicocelectomy? Summary answer Patients with bilateral varicocele have significantly worse clinical presentation than unilateral disease. Significantly greater improvement in total motility was detected with bilateral varicocele ligation. What is known already Varicocele is a common clinical condition with significant implications on male fertility potential. In the majority of cases, varicocele is unilateral affecting the left spermatic veins. Nonetheless a minority of patients may present with bilateral clinical disease. It is not entirely clear whether patients with bilateral clinical varicocele can have a more significant deterioration in testicular function than unilateral varicocele patients. Furthermore, a clear comparison of the outcome of varicocele ligation between patients with bilateral and unilateral clinical disease has not been clearly elucidated. Study design, size, duration This retrospective chart review was conducted at a tertiary medical center and included the charts of 1170 age matched patients who underwent microsurgical subinguinal varicocelectomy over an 8 year-period. Patients were classified into 2 groups; group 1 (n = 977; those who underwent unilateral varicocelectomy) and group 2 (n = 193; those who underwent bilateral varicocelectomy). Patients with genetic abnormalities, history of orchitis or chemoradiation were excluded. Participants/materials, setting, methods Patients’ demographics, varicocele grade and laterality, semen results, sperm DNA fragmentation and hormones levels initially and 3 months following varicocele ligation were collected. Frequency, median(IQR) or mean±SD were used to report categorical and numerical values, respectively. Mann-Whitney test and Repeated measures analysis of variance were used for statistical analysis of data. A p value &amp;lt; 0.05 was considered significant. Main results and the role of chance The patients’ mean age and body mass index were 34.5 ± 8.2 years and 28.13 ± 5.8 Kg/m2, respectively. Left varicocele was of grade 1 in 3.5% of cases, grade 2 in 52.8% and grade 3 in 43.7% with a mean diameter of 3.9 ±0.9mm. Right varicocele was of grade 1 in 59.6% of cases, grade 2 in 31.6% and grade 3 in 8.8% with a mean diameter of 2.5 ± 0.9mm. Preoperatively, patients with bilateral varicocele had significantly lower total motility (38 [17, 53.5] % vs 45 [20, 59] %, p = 0.027) and progressive motility (6 [0, 19.7] % vs 10 [0, 25] %, p = 0.039) and significantly higher serum FSH levels (4 [2, 6.1] IU/L vs 3.2 [2, 5.4] IU/L, p = 0.042) than patients with unilateral varicocele. Following varicocele ligation, significant improvements were noted in sperm concentration, total motility and progressive motility in both groups (group 1: p &amp;lt; 0.001 for all; group 2: p = 0.007, 0.003 and 0.003 respectively). Between group comparisons reveal a significantly greater increase in only total motility following surgery in the bilateral varicocele group compared with the unilateral group (median difference +9 [-5, +18] % vs + 5 [-5, +17] %, p = 0.045). Limitations, reasons for caution The retrospective nature of the study is one limitation. Discrepancies in the sample size between the two groups is another limitation though this is affected by the low prevalence of right varicocele. Wider implications of the findings Bilateral clinical varicocele is more detrimental on testicular function than unilateral disease. Proper identification and concomitant treatment of right varicocele may result in a better improvement in male fertility potential. Trial registration number Not applicable

P-054 Impact of age and correction timing on the progression of testicular dysfunction in patients with grade 3 varicocele

Abstract Study question Does varicocele lead to progressive testicular dysfunction If not corrected and Can patients with long history of varicocele benefit from varicocelectomy? Summary answer Varicocele in older patients have more pronounced effect. Correction at a younger age leads to more significant improvement in testicular function and semen parameters. What is known already Varicocele is present in up to 20% of the general adult male population and is more prevalent in men with primary (40%) or secondary infertility (80%). This clinical condition is mostly asymptomatic but can present with persistent scrotal pain in about 10% of cases. More importantly, varicocele has detrimental effect on testicular function due to several pathophysiologic mechanisms including hyperthermia, tissue ischemia, oxidative stress, and reflux of adrenal metabolites. Microsurgical varicocelectomy is considered the gold standard technique with least side effects compared to other modalities. Varicocelectomy is directly associated with improvements in pain and semen parameters and fertility potential. Study design, size, duration This retrospective study was approved by the ethics committee at Hamad Medical Corporation, Doha, Qatar, and has obtained a waiver of informed consent. Records of 1500 patients undergoing microsurgical subinguinal varicocelectomy between January 2017 and July 2020 were collected. Participants/materials, setting, methods The inclusion criteria were infertile patients who presented with a clinical grade 3 varicocele. Patients who were azoospermic or severe oligozoospermic, had genetic abnormalities or received prior infertility medical treatment were excluded. Also, patients with prior history of varicocelectomy, orchidopexy or exposure to gonadotoxins were also excluded. Patients were divided in 2 groups according to age, &amp;lt;40years and &amp;gt; =40years. The preoperative semen analysis and hormonal profile pre-surgery and 6 months post-surgery were collected. Main results and the role of chance 265 patients met the inclusion criteria and were therefore enrolled for data analysis. 210 patients were &amp;lt;40 years and 55 patients &amp;gt;/=40 years at the time of varicocelectomy. The patients' mean age was 33.8±8 years. Older age was found to be significantly correlated with count (-1.42), total motility (-0.166), progressive motility (-0.193), normal morphology (-0.035), FSH (-0.255) and testosterone (-0.204). Comparing the preoperative results between the groups, older patients (&amp;gt;/=40years) showed significantly lower values of total motility (39% vs 48.5% P = 0.04), progressive motility (7%vs 20% P = 0.0004), FSH (4 vs 3 P = 0.005) and testosterone (14.1 vs 17.1 P = 0.002) compared with younger patients. Compared with pre operative parameters, the post operative results in patients &amp;lt;40years showed significant improvement in sperm concentration (33 vs 26.9 p = 0.009), total motility (55% vs 48.5% p &amp;lt; 0.001) and progressive motility (23.5% vs 20% p = 0.022). However, in patients &amp;gt;/=40years, only progressive motility improved significantly (17% vs 7% p = 0.044). By comparing the post-operative results between the groups, the improvement was significantly better in patients &amp;lt;40years regarding total motility (p = 0.01), progressive motility (p = 0.02) and FSH (p = 0.002). Limitations, reasons for caution Retrospective nature Limited number if cases Wider implications of the findings Varicocele will lead to progressive testicular dysfunction if not corrected at younger age Trial registration number not applicable

Microsurgical varicocelectomy for intratesticular varicocele with a history of orchiopexy for undescended testis

IntroductionWe report a case series of six patients with a chief complaint of infertility who underwent microsurgical varicocelectomy for intratesticular varicocele (ITV) after undergoing orchiopexy for undescended testis in their childhood.Case presentationThe patients' median age was 34 years. The median age at which orchiopexy was performed was 4.5 years. All the cases of ITV were accompanied by extratesticular varicocele (ETV). All the patients underwent a microsurgical subinguinal varicocelectomy. At 3 months after operation, the ITV and ETV had disappeared in all the cases. Sperm density and motility increased in five and four patients, respectively.ConclusionITV occurs at a relatively high frequency after orchiopexy for undescended testis. Disorder of the valvular function of the testicular vein in peeling the testicular vessels was thought to be a primary cause and is often found on the left side. Doppler ultrasonography of the testis is considered important for diagnosis.

PD09-11 VEIN DIAMETER ON ULTRASOUND AS PREDICTOR OF SEMEN PARAMETER IMPROVEMENT AFTER VARICOCELECTOMY

You have accessJournal of UrologyCME1 May 2022PD09-11 VEIN DIAMETER ON ULTRASOUND AS PREDICTOR OF SEMEN PARAMETER IMPROVEMENT AFTER VARICOCELECTOMY Leon Telis, Alan Paniagua Cruz, Kirolos Meilika, Hira Chaudhry, Michael Huaman, and Boback M. Berookhim Leon TelisLeon Telis More articles by this author , Alan Paniagua CruzAlan Paniagua Cruz More articles by this author , Kirolos MeilikaKirolos Meilika More articles by this author , Hira ChaudhryHira Chaudhry More articles by this author , Michael HuamanMichael Huaman More articles by this author , and Boback M. BerookhimBoback M. Berookhim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002535.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical presence and grade of varicocele has been associated with the degree of spermatogenic response to varicocelectomy. There have been no objective pre-operative factors that have been found to correlate with spermatogenic improvement post-varicocelectomy. We aim to determine whether preoperative venous diameter on ultrasound may predict semen parameter improvement post-varicocelectomy. METHODS: We performed a retrospective chart review of a single-surgeon cohort of patients undergoing microsurgical varicocelectomy to assess the impact of pre-operative ultrasound varicocele diameter on changes in semen analysis. Sonography was performed at local centers with experience in scrotal Doppler sonography. Maximal internal spermatic vein diameters were reported. Paired t-test and Wilcoxon signed-rank test were used to analyze changes in pre- and post-operative semen parameters. Paired t-test was used to further analyze changes in pre- and post-operative semen parameters among unilateral vs bilateral varicocelectomy. Statistical significance was defined as p <0.05. Kendall rank coefficient was performed to assess correlation of varicocele clinical grade and vein diameter on ultrasound. RESULTS: The last 180 consecutive patients who underwent subinguinal microsurgical varicocelectomy were evaluated. Median age of patients was 32 years (range 19-57). 56 patients with available post-operative semen analyses underwent bilateral repair and 49 patients underwent unilateral repair. Mean time from surgery to post-operative semen analysis was 5.4 months. Men who underwent varicocelectomy with vein diameter >3.5 mm had a significant improvement in sperm concentration. Improvement in sperm motility and morphology was also noted in this cohort and approached statistical significance. Those with varicoceles <3.5 mm did not demonstrate an improvement in semen parameters. Significant improvement in semen concentration and morphology was noted among patients undergoing bilateral repair. There was a statistically significant association between clinical and radiographic varicocele size (tau = 0.391, p <0.001). CONCLUSIONS: We identified an improvement in semen analysis parameters after varicocele repair in men with clinical varicoceles with venous diameter >3.5 mm on ultrasound. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e181 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leon Telis More articles by this author Alan Paniagua Cruz More articles by this author Kirolos Meilika More articles by this author Hira Chaudhry More articles by this author Michael Huaman More articles by this author Boback M. Berookhim More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effect of varicocelectomy on detailed sperm morphology parameters: An observational retrospective clinical cohort study.

Although many studies suggest that varicocelectomy leads to improvement in semen parameters and morphology, its clinical efficacy remains controversial. The detailed morphological parameters described in the World Health Organization guidelines are important in terms of showing the effect of microsurgical subinguinal varicocelectomy on morphological changes.An observational, retrospective clinical cohort study was conducted with patients followed up from January 2018 to August 2021. This study included the data of 79 patients who met the criterion of undergoing at least 2 detailed morphological evaluations before and after surgery. All operations were performed by the same surgical team using the microsurgical subinguinal varicocelectomy technique.The mean age of the patients was 30.25 years. Of the patients, 63 underwent left-sided varicocelectomy and 16 underwent bilateral surgery. The sperm analysis revealed statistically significant increases in sperm volume (P = .006), sperm concentration (P = .003), total sperm count (P = .001), progressive sperm motility (P < .001), and normal morphology (P < .001). In the detailed morphological evaluation, except for the elongated head anomaly (P = .037), no other statistically significant changes were found in relation to sperm head, tail, and neck anomalies after surgery.This study makes an important contribution to the literature, being the first to use the subinguinal microscopic varicocelectomy technique in detailed morphological semen evaluation. We consider that detailed morphology examination in the selection and treatment of infertile patients may be useful in evaluating the efficacy of varicocelectomy.