title: Relationship between grade of varicocele and the response to varicocelectomy.
abstract: BACKGROUND
  Although several studies indicate that larger varicoceles are associated with greater impairment of spermatogenesis, others suggest that the response to surgery is independent of varicocele size. In order to elucidate these seeming contradictions, correlations between the preoperative evaluation of varicoceles and improvement in semen quality after varicocelectomy were investigated.
  
  
  METHODS
  Forty men with left unilateral varicocele, followed for at least 6 months after varicocelectomy, were included in this study. The relationships between the grade of varicocele by palpation, Doppler examination, ultrasound, or scintigraphy were correlated with a postoperative improvement in sperm density or sperm motility.
  
  
  RESULTS
  Greater improvement in sperm density was observed in the patients with a large varicocele graded by palpation or measured by ultrasound, and greater improvement in sperm motility was observed in the patients with high uptake of radioactivity in the left side by scrotal scintigraphy.
  
  
  CONCLUSIONS
  An improvement in semen quality after varicocelectomy is greater in patients with a large varicocele than in the patients with a small one. The significance of surgical repair of a small varicocele should be reconsidered.
authors.affiliation: Department of Urology, School of Medicine, Chiba University, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Takahara
authors.forename: T
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Shiseki
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: J
authors.initials: J
authors.lastname: Shimazaki
mesh_terms: D000792:Angiography; D006801:Humans; D008297:Male; D010173:Palpation; D011877:Radionuclide Imaging; D012611:Scrotum / Q000000981:diagnostic imaging; D013076:Sperm Count; D013081:Sperm Motility; D016896:Treatment Outcome; D014463:Ultrasonography; D014646:Varicocele / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*