title: Does the number and size of veins ligated at left-sided microsurgical subinguinal varicocelectomy affect semen analysis outcomes?
abstract: OBJECTIVE
  To determine whether the preoperative and intraoperative findings at unilateral microsurgical subinguinal varicocelectomy are predictive of semen analysis changes postoperatively.
  
  
  METHODS
  We identified 42 men who had undergone left-sided microsurgical subinguinal varicocelectomy at our institution and had at least one semen analysis before and after surgery. The preoperative varicocele grade and number and size of spermatic cord veins ligated were recorded. The veins were defined as small (less than 1.0 mm), medium (1.0 to 3.9 mm), and large (4.0 mm or larger). The generalized estimating equation approach was used to assess whether patient age, varicocele grade, number of small, medium, or large veins ligated, total number of veins ligated, and net diameter of all veins ligated were predictive of repeated measurements of semen analysis outcomes.
  
  
  RESULTS
  Increasing patient age was associated with a slight decline in sperm concentration (P = 0.046). The number of veins ligated correlated positively with an increase in total motility (P = 0.017). The repair of grade II varicoceles was associated with a significantly greater increase in normal morphology than did the repair of grade I or III varicoceles (P = 0.004). None of the other variables examined were predictive of semen analysis outcome (P >0.05).
  
  
  CONCLUSIONS
  The relationship between the preoperative/intraoperative findings and semen analysis outcomes after microsurgical subinguinal varicocelectomy remains unclear.
authors.affiliation: Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. shindela@wudosis.wustl.edu
authors.forename: Alan W
authors.initials: AW
authors.lastname: Shindel
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: Cathy K
authors.initials: CK
authors.lastname: Naughton
mesh_terms: D000328:Adult; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008297:Male; D012661:Semen / Q000166:cytology*; D012720:Severity of Illness Index; D013076:Sperm Count; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects; D014646:Varicocele / Q000601:surgery*; D014680:Veins / Q000601:surgery