[The treatment of varicocele in the infertile male I: results on semen quality].
OBJECTIVE
To evaluate the effect of interventionist treatment of varicocele, either open surgery or endovascular radiological occlusion, on seminal parameters, and to identify which factors are associated with their normalization.


METHODS
Between 1975 and 2000, 631 patients with the diagnosis of idiopathic varicocele were evaluated in our hospital; 238 of them were part of an infertile couple. Among them, finally, 183 underwent studies; they complied with the following criteria: 1) Infertility for more than one year; 2) seminal parameters below normality following WHO criteria (1992); 3) absence of other pathologies or diseases which could explain male infertility; and 4) absence of evident causes of male infertility. 131 patients were treated by radiological occlusion and 26 by conventional surgery. The remaining 26 patients did not undergo the treatment indicated. Two parameters were evaluated on follow-up: 1) achievement of pregnancy (these results will be analyzed in a next article), and 2) normalization of seminal parameters.


RESULTS
48% and 39% of the patients respectively achieved normalization of the number of spermatozoids per ml (=20 million spermatozoids per ml) and spermatic morbidity (=50%). The association between normalization of seminal parameters and age, clinical grade, or type of treatment was not demonstrated. Only baseline degree of severity in the alteration of seminal parameters showed statistically significant differences in the evaluation of semen quality after treatment of varicocele (p = 0.001 and p = 0.002).


CONCLUSIONS
The degree of previous seminal alteration--oligospermia and asthenospermia--was the factor with greatest prognostic value in relation with normalization of seminal parameters.
Pamplona Casamayor
Manuel
M
Servicio de Urología, Hospital Doce de Octubre, Madrid, España.
Duarte Ojeda
José Manuel
JM
Villar Esnal
Roberto
R
Bolea Laguarta
M Angeles
MA
de la Cruz Bértolo
Javier
J
Alvarez González
Enrique
E
Rodríguez Antolin
Alfredo
A
Leiva Galvis
Oscar
O
D000328:Adult; D006801:Humans; D007248:Infertility, Male / Q000150:complications / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D012661:Semen; D013076:Sperm Count; D013081:Sperm Motility; D013094:Spermatozoa; D014646:Varicocele / Q000150:complications / Q000628:therapy*