Clinical study of varicocele: statistical analysis and the results of long-term follow-up.
BACKGROUND
The results of clinical examinations of varicocele and the clinical outcome of varicocelectomy conducted at Tsukuba University Hospital, Tsukuba City, Japan were analyzed.


METHODS
The subjects of the present study were sixty-four infertile male patients with varicocele who visited our hospital from 1991 to 1999. A physical examination, semen analysis and hormonal evaluation were performed for each patient. Patients selected their preferred type of treatment (varicocelectomy or conservative treatment) after providing their informed consent.


RESULTS
The age of the patients was 34.1 +/- 5.1(mean +/- standard deviation [s.d.]) years, and the infertile duration was 4.2 +/- 3.0 (mean +/- s.d.) years. Fifty-one cases were left-sided; 13 were bilateral. Mean sperm density ( yen 106/mL) was 37.2 for Grade I, 21.3 for Grade II and 9.4 for Grade III. Sperm density was significantly lower in the higher-graded patients (P = 0.008). Varicocelectomy was performed in 31 cases; the postoperative/preoperative ratio of sperm density was significantly higher in the higher-graded varicocele (P = 0.04), and the peak/base ratio of follicle-stimulating hormone (FSH) after luteinizing hormone-releasing hormone (LH-RH) stimulation was significantly decreased after varicocelectomy (P = 0.007). The pregnancy rate in the partners of the varicocelectomized group (60%) was significantly higher than in the conservatively treated group (28%) P = 0.04; the mean follow-up duration was 76.2 months.


CONCLUSIONS
These results show that varicocele should influence spermatogenesis, therefore altered spermatogenesis could be effectively treated by varicocelectomy, and varicocelectomy should induce a higher probability of pregnancy.
Onozawa
Mizuki
M
Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Japan. uro_secretary@mail.goo.jp
Endo
Fumiyasu
F
Suetomi
Takahiro
T
Takeshima
Hitoshi
H
Akaza
Hideyuki
H
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007248:Infertility, Male / Q000209:etiology*; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate; D012661:Semen; D012720:Severity of Illness Index; D013076:Sperm Count; D013081:Sperm Motility; D016896:Treatment Outcome; D014646:Varicocele / Q000150:complications* / Q000601:surgery*
D012739:Gonadal Steroid Hormones