Varicocelectomy in men with nonobstructive azoospermia: is it beneficial?
OBJECTIVE
To investigate the effect of open lymph sparing high ligation varicocelectomy in nonobstructive azoospermic men with palpable varicocele and determine predictive parameters of outcome.


METHODS
After a standard diagnostic evaluation, a total number of 83 men with nonobstructive azoospermia (54 men with complete azoospermia and 29 with virtual azoospermia) and palpable varicocele underwent open lymph sparing high ligation varicocelectomy. Testicular core biopsy was also performed perioperatively in all patients. Varicocelectomy was performed bilaterally in 60 patients and unilaterally in 23. The outcome success was assessed in terms of improvement in semen parameters and spontaneous pregnancy. Four patients with recurrent varicocele were excluded from final data analysis.


RESULTS
After a mean follow up of 7.4 months, motile sperm in the ejaculate could be identified in 27 (34.2%) nonobstructive azoospermic patients with a mean postoperative sperm count of 3.56+/-4.8 x 106/mL (range 0.3-18.9) and a mean sperm motility of 42.24+/-17.64% (range 24-76). No predictive parameters of postoperative improvement other than testicular histopathology could be concluded. Of these 27 patients, 2 had Sertoli-only-cell pattern, 6 had maturation arrest at spermatid stage pattern, 13 had hypospermatogenesis and 8 had normal spermatogenesis. Spontaneous pregnancy was achieved in 6 (7.7%) patients. Of these 6 patients, 2 had maturation arrest at spermatid stage pattern, 2 had hypospermatogenesis and 2 had normal spermatogenesis. No predictive parameters of spontaneous pregnancy achievement could be concluded.


CONCLUSIONS
High ligation varicocelectomy may offer nonobstructive azoospermic men an opportunity to have motile sperm via ejaculate and even the chance of natural conception, instead of the more bothersome assisted reproductive techniques.
Youssef
Tamer
T
Surgery Department, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt. tamyousif@yahoo.com
Abd-Elaal
Ebraheim
E
Gaballah
Ghada
G
Elhanbly
Samir
S
Eldosoky
Ebraheim
E
D000328:Adult; D053713:Azoospermia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007248:Infertility, Male / Q000209:etiology / Q000503:physiopathology; D008026:Ligation / Q000379:methods; D008297:Male; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D013076:Sperm Count; D013081:Sperm Motility / Q000502:physiology; D013091:Spermatogenesis / Q000502:physiology; D013737:Testis / Q000473:pathology* / Q000503:physiopathology; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods; D014646:Varicocele / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*