Microsurgical Subinguinal Varicocelectomy Research Articles

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.

Indocyanine green angiography and lymphography in microsurgical subinguinal varicocelectomy with evolving video microsurgery and fluorescence imaging platforms.

Indocyanine green angiography and lymphography in microsurgical subinguinal varicocelectomy with evolving video microsurgery and fluorescence imaging platforms.

Testicular pain improvement after microsurgical subinguinal varicocelectomy

Background: Approximately 2–10% of patients with varicocele complain of testicular pain. When conservative therapy fails to relieve the pain, Varicocelectomy is the surgical choice. The success rate of varicocelectomy for testicular pain has varied among studies. This prospective study aimed to investigate success rate of microscopic subinguinal varicocelectomy performed for the treatment of painful varicocele. Aim: To assess the efficacy of microsurgical subinguinal varicocelectomy for relief of testicular pain. Methods: The study was conducted at KasrAlainy school of medicine on 25 male patients who did not have infertility concerns and underwent microscopic subinguinal varicocelectomy with standard and pulling techniques after failed conservative treatment for 3 months. Results: 25 patients with testicular pain due to varicocele underwent microsurgical subinguinal varicocelectomy, 92% of patients had resolution of pain on follow up. Conclusion: Microscopic subinguinal varicocelectomy is an effective surgical alternative for testicular pain.

Indigo Carmine Dye–Assisted Lymphatic-Sparing Microsurgical Subinguinal Varicocelectomy Among Children and Adolescents

The purpose of this study is to clarify the safety and efficacy of indigo carmine dye–assisted lymphatic-sparing microsurgical subinguinal varicocelectomy for children and adolescents in our institution. Medical records of boys aged ≤ 15 years who underwent varicocelectomy between November 2008 and December 2019 at our institution were retrospectively reviewed. Microsurgical subinguinal varicocelectomy was performed using indigo carmine injection under the tunica vaginalis to preserve lymphatics. A total of 29 patients underwent varicocelectomy, among whom six underwent retroperitoneal high ligation (modified Palomo technique), nine underwent laparoscopic varicocelectomy, and 14 underwent microsurgical subinguinal varicocelectomy. The median operative time for retroperitoneal high ligation, laparoscopic varicocelectomy, and microsurgical subinguinal varicocelectomy was 71 (IQR: 59–82.5) min, 131 (95–151) min, and 125.5 (112–134.25) min, respectively. Among the patients who underwent laparoscopic varicocelectomy, one and two experienced hydrocele and varicocele recurrence as postoperative complications, respectively. None of the patients who underwent microsurgical subinguinal varicocelectomy developed hydrocele and varicocele recurrence during 15.5-month median follow-up period (IQR: 11.25–25.75 month). Indigo carmine dye–assisted lymphatic-sparing microsurgical subinguinal varicocelectomy can be a safe and efficient treatment modality among children and adolescents.

Preliminary experience with 3D digital image microscope system on the treatment of varicocele.

The three-dimension digital image microscope system (3D-DIM) with a better ergonomic design and equipment characteristics can contribute to the achievement of good results during microsurgery. In this study, the safety and efficiency of 3D-DIM assisted varicocelectomy was evaluated. From July 2019 to November 2019, fifteen cases with varicocele (20 sides of varicocele in total) were included, seven cases underwent 3D-DIM-assisted modified microsurgical subinguinal varicocelectomy, and eight cases underwent modified microsurgical subinguinal varicocelectomy under standard operating microscope (SOM). The mean operative time of 3D-DIM group (67±12.3min) was a little longer than that of SOM group (55±12.9min) (p<0.05). There was no significant difference between the two groups in the number of internal spermatic arteries, internal spermatic vein, lymphatics, gubernacular vein, external spermatic vein and post-operation complications. The 3D-DIM showed a significant difference in image definition for nurse (p<0.01) and in doctor-nurse cooperation (p<0.05) over SOM. The 3D-DIM with better ergonomic design and image definition can be applied to perform microsurgical subinguinal varicocelectomy, and could improve the surgeon's fatigue and doctor-nurse cooperation. We believe that the 3D-DIM would be widely used in the field of male infertility microsurgery in the near future.

Результаты применения комплекса БЕСТФертил у пациентов после микрохирургической подпаховой варикоцелэктомии (операции Мармара)

Up to 15% of couples around the world face the problem of infertility, while male factor in infertile marriages occurs in up to 50% of cases. Varicocele occurs in 15% of the male population and in 35% of men with infertility. For now, the only effective method of treating varicocele is operative. After surgical treatment, there is an improvement in spermogram parameters, however, it is not always possible to achieve normal value of each parameter.To assess the efficiency of BESTFertil in patients after varicocelectomy.The single-center, prospective, randomized study at the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov was conducted comparing the postoperative parameters of patients who underwent varicocelectomy, followed by the course of BESTFertil (main group) and without it (control group). A total of 63 patients were included in the study: the main group - 33 patients and the control group - 30 patients. The inclusion criteria for the study were: the presence of varicocele as the cause of pathospermia and / or the absence of pregnancy in marriage for 12 months or more of regular sexual activity without contraception, in the absence of other organic pathology as a possible cause of infertility, age from 18 to 45 years. Patients from both groups underwent surgical treatment of varicocele - microsurgical subinguinal varicocelectomy according to the standard Marmar technique using an operative microscope. Patients from the main group received BESTFertil for 3 months according to the recommended scheme.In the main group an average increase in the volume of ejaculate in 6 months was 0.48 ml (11.2% of the initial), the increase in concentration was 24.4 mln / ml (59.1%), the increase in motility was 25.2% (69.2%), morphologically normal forms - 3.4% (106.3%). A relapse of the disease was revealed in one patient, according to ultrasound and angiography, however, there was also a positive dynamic of spermogram parameters: an increase in ejaculate volume - 0.8 ml; increase in sperm concentration - 22 mln/ml; A + B motility-32%; morphologically normal forms - 1%. Four patients (16.7% of the total number of patients with infertile marriage in the main group) reported pregnancy. In the control group, an average increase in the volume of ejaculate in 6 months was 0.07 ml (1.7% of the initial), the increase in concentration was 11.7 mln / ml (27%), the increase in motility was 10.6% (32.7%), morphologically normal forms - 0.6% (9.8%). Two patients (9.1% of the total number of patients with infertile marriage in the control group) report pregnancy after treatment. One patient had a relapse of the disease, confirmed by angiography, despite his spermogram parameters correspond to normospermia.These results allow us to conclude that the course of BESTFertil in patients after treatment of varicocele allows to achieve a clinically and statistically significant increase in spermogram indicators such as ejaculate volume, its concentration, sperm motility and the number of morphologically normal forms, which can help patients achieve natural pregnancy or resort to assisted reproductive technologies.

Modern approaches to the surgical treatment of varicocele in childhood

In the structure of male infertility, varicocele is being detected in 30–40 % cases of primary infertility, and in 80 % cases of secondary infertility. At the age of 10 years during the screening, only 1 % of boys have a varicocele, but in the pubertal period this figure increases to 15–20 %. Indications for surgery in childhood differ from those in adults, since grade III varicocele must be associated with ipsilateral testicular atrophy more than 20 % compared to contralateral, or combined with pain. Surgical methods of varicocele treatment are different. Discussions are ongoing regarding the choice of ligation of the internal spermatic vein. There is no general agreement on the technique of surgical intervention. There are about 100 different methods of internal spermatic vein ligation in the world, the most popular of which are the retroperitoneal approach according to Palomo, transinguinal access according to Ivanissevich, subinguinal ligation according to Marmar, vascular embolization and laparoscopic suprainguinal approach. Currently, there is no gold standard for surgical treatment of varicocele in pediatric surgery in contrast to adulthood, where microsurgical subinguinal varicocelectomy has already become a classic method of intervention. This is due to a lower complication rate compared to high ligation. Subinguinal varicocelectomy can sometimes lead to testicular atrophy due to damage to the testicular artery, which is difficult to visualize during surgery. In childhood, Marmar operation is complicated by the small size of the spermatic cord structures, which requires the search for new methods of intraoperative visualization of vascular structures. In this article, intratesticular injection of 1% methylene blue was used for lymphatic vascular contrast and indirect visualization of the testicular artery, which allows for the use of subinguinal varicocelectomy in adolescents.

A Systematic Review and Meta-analysis of the Efficacy of Intraoperative Vascular Doppler Ultrasonography for Vein Ligations and Artery Preservations in Microsurgical Subinguinal Varicocelectomy

The gold standard of varicocele management is microsurgical subinguinal varicocelectomy. This procedure leads to better preservation of the testicular artery and lymphatic vessels. However, sometimes several vessels were in complex position causing the dissection to be more difficult. By using IVDU, more arteries and veins could be identified to acquire better sperm outcomes. It's uncertain if the Doppler Ultrasonography has a role in varicocele therapy. The goal of this systematic review and meta-analysis was to see how effective microsurgical subinguinal varicocelectomy with intraoperative vascular Doppler ultrasonography compared to without intraoperative vascular Doppler ultrasonography. Randomized Controlled Trials (RCTs), non-randomized trials, and comparative observational studies were searched and screened in the Embase, Medline, and Scopus databases for research examining the role of intraoperative Doppler ultrasonography. The Cochrane risk of bias (RoB) tool 2 was used to assess RCT bias, whereas the ROBINS-I tool was utilized to assess non-randomized trial bias. The New Ottawa Scale was used to evaluate observational research. The systematic search and screening yielded five suitable studies, including three RCTs, one non-randomized trial, and one observational research. Between patients receiving IVDU and those having the treatment without IVDU, there is a significant difference in the number of ligated veins (MD 0,94; 95 percent CI 0,62?1,26; p0,00001) and preserved arteries (MD 0,43; 95 percent CI 0,30?057; p0,00001). Patients receiving IVDU had better ligated veins and preserved arteries than patients having the surgery without IVDU.

Effect of Varicocelectomy on Semen Parameters of Men Seeking Infertility Treatment in Tamale, Ghana

The study aimed to determine the effect of microsurgical sub-inguinal varicocelectomy on semen parameters among men seeking infertility treatment in Ghana. This was an intervention study conducted at Tamale Teaching Hospital in the Tamale Metropolis from September 2017 to August 2021. The study involves two groups; the surgery group (n = 75) and the observed group (n = 63). Duplicate semen samples (mean values adopted) were collected at the onset and assessed according to the criteria established by World Health Organization (WHO), 2010. Varicocelectomy was performed for the surgery group and no intervention was given to the observed group. The two groups were followed for 180 days and repeated semen samples were collected and analyzed. The data was computed using GraphPad Prism (v8.0) at an alpha of 0.05. All the men had varicocele and were aged between 46.0 and 67.0 years old. There was no difference between semen parameters among the two groups before the surgery. However, after 180 days of follow-up, all of the semen parameters significantly improved in the surgery group (p < 0.0001), while sperm concentration (p = 0.0068), progressive motility (p = 0.0281), and normal sperm morphology (p = 0.0015) decreased in the observed group. The surgery group had an overall percent increase in total sperm count (840.7%; p = 0.0197), sperm concentration (582.1%; p = 0.0125), total viable sperms (155.2%; p < 0.0001), and normal sperm morphology (110.9%; p < 0.0001) while immotile sperms (-51.71%; p < 0.0001) reduced. A pregnancy rate of 25.3% (19/75) was reported among the surgery group but none was reported among the observed group after 180 days. Microsurgical sub-inguinal varicocelectomy improves semen parameters and hence effective treatment of infertile men with a clinically palpable varicocele. It is recommended to use this choice for similar patients, however, further studies with a larger sample size are needed to provide more evidence to recommend this therapy.

Effect of Varicocelectomy on Gonadal Function among Patients Reporting with Sexual Dysfunction in Ghana

Background: Long-standing varicocele is often associated with testicular hypoxia and that might worsen Leydig cell function, a significant risk factor for hypogonadism. This may affect both the secretory and endocrine functions of the testis. This study aims to determine the effect of microsurgical sub-inguinal varicocelectomy on gonadal function among men reporting sexual dysfunction in Ghana. Methods: This was an intervention study conducted at the Tamale Teaching Hospital from September 2017 to August 2021. A total of 103 participants were randomized into two groups; the surgery group (n = 52) and the observed group (n = 51). Venous blood samples were collected at baseline, varicocelectomy was performed for the surgery group, and no intervention was given to the other. Blood samples were subsequently collected at 12-, 24-, 36-, and 48-month intervals for assay of serum total testosterone, FSH, and LH. The data were analyzed in GraphPad Prism (v8.0) at an alpha value of 0.05. Results: All the participants had varicocele and were aged between 55.0 to 69.0 years old. At the baseline of the study, all participants presented with sexual dysfunction but a significant improvement (p < 0.001) in the GRISS score, and the subscale was observed 12 months after the surgery. The mean ± SD serum total testosterone (p = 0.6078), FSH (p = 0.6522) and LH (p = 0.2281) between the groups at baseline did not vary but those in surgery group had improved values at 12-, 24-, 36- and 48-month post-surgery (p-trend < 0.0001). The surgery group had an overall percent increase in serum total testosterone (76.3%, 194.0%, 221.0%, and 231.9%) over 12-, 24-, 36- and 48-month and significant percent reduction in both FSH (-14.7%, -29.9%, -33.8% and -40.8%) and LH (-21.8%, -31.0%, -32.4%, and -36.4%) respectively. These gonadotropins observed annual percentages spike within the first and second year but changes were marginal from the third year onwards in the surgery group. Conclusions: Microsurgical sub-inguinal varicocelectomy improved gonadal function among varicocele patients reporting sexual dysfunction. It is recommended to use this choice for similar patients; however, these findings should be verified by a multi-institutional study to provide more evidence for this choice.

Preliminary experience with indocyanine green lymphography during microsurgical subinguinal varicocelectomy

AbstractObjectiveThe aim of the present study was to evaluate the feasibility to expand the use of indocyanine green (ICG) to lymphatic‐sparing microsurgical subinguinal varicocelectomy (MSV) in addition to ICG angiogram by using video microsurgery platform.Patients and MethodsSeven patients with 12 varicoceles had MSV and intraoperative ICG lymphography performed from July 2019 to February 2020. Intraoperative ICG lymphography was employed to confirm and preserve lymphatics after intra‐parenchymal testicular injection of ICG.ResultsLymphatic vessels were clearly identified on ICG lymphography in all varicocele units with intra‐parenchymal testicular injection. ICG lymphography did not significantly interfere with the quality of subsequent ICG angiography in the majority of patients. All patients were discharged uneventfully within 24 h after the operation. No complications were reported with a median follow up duration of 9 months.ConclusionsThe use of intraoperative ICG lymphography consistently provides objective assessment of lymphatic vessels during the procedure of MSV.

Comparison of Open Sub-Inguinal and Microscopic Sub-Inguinal Varicocelectomy for Improvement of Sperm Parameters

Background: Varicoceles along with oligospermia as well as with asthenozoospermia lead to the male infertility. It can weaken the spermatogenesis via many different pathophysiological mechanisms. Many surgical and non-surgical methods are available for its treatment. Objective: To compare microscopic versus open sub-inguinal varicocelectomy in males with varicocele with oligospermia and asthenozoospermia. Study Design: Randomized controlled trail Place and Duration of Study: Department of Urology, Lahore General Hospital, Lahore from 1st May to 30th November 2017. Methodology: One hundred and fifty males with varicocele were recruited and divided in two equal groups. Group A patients underwent microsurgical sub-inguinal varicocelectomy and Group B patients underwent conventional/open sub-inguinal varicocelectomy. Semen analysis was done before surgery and after four months of surgery and 50% improvement in semen parameters were noted. Results: The mean age was 31.69±5.49 years. In group A and group-B ≥50% improvement was observed in 36 (48%) and 21 (28%) respectively. The improvement was significantly higher in group A than group B (p&gt;0.012). Conclusion: The improvement in sperm count and motility was significantly higher in patients treated with microsurgical sub-inguinal varicocelectomy when treated with conventional/open sub-inguinal varicocelectomy. Keywords: Male infertility, Varicocele, Varicocelectomy, Seminal parameters, Microsurgical sub-inguinal, Conventional/open sub-inguinal

Clinical effectiveness of microsurgical subinguinal varicocelectomy with enhanced recovery after surgery for varicocele.

BackgroundVaricocele (VC) is one of the most common causes of infertility in men, and microscopic varicocelectomy is currently the major surgical procedure for VC. We assessed the clinical effectiveness of microsurgical subinguinal varicocelectomy (MSV) with enhanced recovery after surgery (ERAS) in the treatment of VC in terms of semen quality improvement rate, pregnancy rate, pain relief rate, recurrence rate, and complication rate after MSV and explored the indications for VC surgery.MethodsIn total, 216 patients undergoing MSV in our center between June 2019 and July 2020 were enrolled in this study. All patients received the surgery under local anesthesia and were admitted and discharged within 24 hours. All patients were followed up for more than 6 months, and the rates of semen quality improvement, pregnancy, pain relief, recurrence, and postoperative complications were recorded. We can evaluate the pain degree of patients through the numerical rating scale (NRS). (I) 0 points for painless; (II) 1–3: mild pain; (III) 4–6: moderate pain; (IV) 7–10 points are severe pain. 0 is the most slightly, indicating comfort, and 10 is the most painful and unbearable.ResultsThe sperm concentration, total sperm count, progressive motility rate, sperm viability, and morphology were significantly improved after the surgery (all P values <0.05). The rate of semen quality improvement was 88.2%, and the semen indicators returned to normal in 26.6% of the patients. Among the patients who were followed up for 1 year, the natural conception rate reached 27.1% and was accompanied by a 95.5% pain relief rate, a 0.5% VC recurrence rate, and a 2.3% postoperative complication rate.We obtained data through laboratory examination of semen DNA fragments index (DFI). Compared with preoperative and postoperative DFI, postoperative DFI was improved, and the pregnancy outcome was improved.ConclusionsMSV under local anesthesia increases the rates of semen quality improvement, pregnancy, and pain relief while lowering the rates of recurrence and postoperative complications. MSV may also help to improve the pregnancy outcomes in patients with VC accompanied by sperm DNA fragmentation or nonobstructive azoospermia, but this should be verified by further investigation.

P–014 Effect of microsurgical varicocelectomy on fertility outcome and treatment plans of patients with severe oligozoospermia: An original report and meta-analysis

Abstract Study question Does microsurgical subinguinal varicocelectomy (MSV) improve semen parameters and fertility outcomes of patients with severe oligozoospermia (SO) and clinical varicocele? Summary answer MSV significantly improves semen parameters of patients with SO and can broaden their fertility treatment options. What is known already: Varicocele ligation has been proven to restore semen parameters and improve pregnancy rates in men with clinically palpable disease. However, its effect in men with SO is less clearly elucidated. Patients with SO are candidates for in vitro fertilization and intracytoplasmic sperm injection. Improvements in semen quality following varicocele ligation in this patient population may broaden their fertility options. While few studies indicate an improvement in semen parameters, reports revealing a negative outcome following surgery in this patient group were also published. Study design, size, duration This original report and meta-analysis examined the impact of MSV on semen parameters and fertility outcomes of men with SO. A retrospective chart review of 85 patients was conducted on patients with SO who underwent MSV. A literature search was carried out according to the PRISMA guidelines using the key words “severe oligozoospermia” and “varicocele”. 8 scientific articles (including the current study) reporting the impact of MSV on men with SO were included. Participants/materials, setting, methods Changes in semen parameters postoperatively were compared with pre-operative results. The reported natural pregnancy rates were also calculated. The Wilcoxon signed-rank test was used to compare semen and hormone values before and after varicocelectomy. The Chi-squared test was used to assess the changes in TMSC groups after surgery. The meta-analysis was performed using comprehensive meta-analysis software (Biostat, Englewood, NJ, USA). Statistical significance was set at α = 0.05. The random-effects model was used to adjust for heterogeneity. Main results and the role of chance The original study reported significant improvements in sperm concentration (p &amp;lt; 0.001), total motility (p = 0.003), progressive motility (p = 0.002) and TMSC (p &amp;lt; 0.001) was following the surgery. in semen parameters following surgery. 78 patients had a pre-operative TMSC &amp;lt; 5 million. Following surgery, 9 (11.5%) patients had a TMSC between 5–9 million, while 14 (17.9%) patients had a TMSC &amp;gt; 9 million. The meta-analysis shows a statistically significant increase in sperm count following surgery (MD 5.64, 95% CI, 4.195–7.090, p = 0.00) with an acceptable degree of heterogeneity (Q value= 8.75, p = 0.188, I²= 31.5%). Similarly, the total motility significantly increased by 7.77% (p = 0.001) following surgery (95% CI, 3.248–12.297), however, with considerable heterogeneity among the reported results (Q value= 34.4, p &amp;lt; 0.001). TMSC was assessed by three studies, including ours. The meta-analysis shows a significant increase in TMSC following surgery (MD 8.44 million sperm, 95% CI, 4.648–12.228, p &amp;lt; 0.001) (Q Value= 2.53, p = 283, I²=20.7%). A total of 6 studies reported the natural pregnancy rate of patients with SO who underwent surgery. Out of 530 patients with preoperative SO, 146 patients achieved natural pregnancy following surgery indicating that the reported pregnancy rate was 27.5%. Limitations, reasons for caution One limitation to the original study is its relatively small sample size. However, this was compensated by conducting a meta-analysis and reporting the outcome of 601 patients with SO who underwent varicocele ligation. Another limitation is the retrospective nature of the study design. Wider implications of the findings: 29.5% of SO patients in the original study became eligible for IUI following varicocelectomy. Meta-analysis showed that 27.5% of patients achieved natural conception following surgery. Such information is beneficial during patient counselling and needs to be measured against the financial and clinical implications in order to make sound treatment decisions. Trial registration number NA

P–078 Prognostic factors for male fertility recovery after microsurgical varicocelectomy

Abstract Study question What clinical and laboratory parameters are reliable predictors of spontaneous pregnancy (SP) after microsurgical varicocelectomy in men from infertile couples? Summary answer Predictors of SP after microsurgical varicocele repair are the male age, baseline total sperm motility, and postoperative increase level of TPMSC. What is known already Varicocele is the most common correctable cause of male subfertility. According to the recent meta-analyses and studies, microsurgical varicocelectomy is the “golden standard” method for varicocele repair. However, it is still unclear why at least one-third of subfertile men do not experience improvement in semen parameters and more than half of them do not report fertility recovery after varicocelectomy. There is no consensus so far on the factors affecting the efficacy of varicocele repair in men from infertile couples. Study design, size, duration This retrospective study comprises 93 men from infertile couples, with palpable varicocele, astheno-/oligozoospermia, and who underwent microsurgical subinguinal or inguinal varicocelectomy from September 2015 to May 2019. Participants/materials, setting, methods The changes in semen analysis were assessed (in 3–6 months after surgery) according to WHO–2010, spontaneous pregnancy (SP) rates after surgery also were considered. A stepwise discriminant analysis was performed to identify predictors of SP after varicocelectomy. An increase in TPMSC by at least 12.5 million was defined as a significant effect (SE) of varicocelectomy (reference values for the total number and progressive sperm motility according to WHO–2010: 39 million x 0.32 (32%) progressively motile). Main results and the role of chance Almost all semen parameters (except for semen volume) changed positively after surgery. Sperm concentration increased from 62 mln/ml (17–107) to 85 mln/ml (39–134) p &amp;lt; 0.001, TPMSC increased by an average of 27 mln (2.8 times; p &amp;lt; 0.001). SE was observed in 52% of cases (n = 48), a slight favorable effect in 21% (n = 20), and no effect in 27% (n = 25). 29 patients (31%) reported SP within a year after varicocele repair. 83% of patients (24 from 29) who reported pregnancy after varicocelectomy showed SE. According to the stepwise discriminant analysis, significant predictors of pregnancy after varicocelectomy were the male age (coefficient of the canonical discriminant function = –0.16), the initial total sperm motility (0.02), and the postoperative increase of TPMSC (0.01). Wilks’ lambda was 0.67 and canonical correlation 0.57. The predictive ability of the prognostic model (discriminant function) with these three predictors was 84%, specificity 87%, and sensitivity 76%. The function real predictive accuracy for SP was 70% (21 correct out of 30 predicted). Limitations, reasons for caution The small sample size and the inability to obtain accurate data on the health condition of female partners were the main limitations of the study. Nevertheless, the findings are statistically significant, which suggests that they can be extrapolated to the general sample of subfertile men with clinical varicocele. Wider implications of the findings: The proposed algorithm (function) for the prediction of SP showed satisfied predictive accuracy, and after its external validation can be recommended in 3–6 months after varicocele repair to decide whether it is advisable to expect an SP within a year or to include an infertile couple in ART programs immediately. Trial registration number Not applicable