Does the number of veins ligated during varicococele surgery influence post-operative semen and hormone results?
Varicocele is a well-established cause of male subfertility, which is directly proportional to its clinical grade. Although newer ultrasonic grading systems have taken into account the existence of pampiniform venous plexi, little is known about the clinical significance of the number of veins ligated during surgery. Very few undersized studies reported an influence which triggered the need to evaluate such association. This is a retrospective study of 378 patients who underwent left microsurgical subinguinal varicocoelectomy. Semen analyses and blood hormone studies performed pre-operatively were compared to those executed 6 months after surgery. Patients were divided into abnormal semen and normal semen groups based on their initial semen results. They were also subdivided according to the number of veins ligated intraoperatively into three groups: <5, 5-10, and >10 veins. Sperm count, total motility, and progressive motility were significantly increased in 62, 60.3, and 53.3% of patients post-operatively (p = 0.001), respectively. No significant differences in hormone levels were detected overall. Of the 378 patients, 332 had an abnormal semen analysis, while the remaining 46 patients had a normal result. Sperm count, total motility, and progressive motility significantly increased after varicocoelectomy in patients with an abnormal initial semen analysis (p = 0.001). In 48.7% of patients, 5-10 veins were ligated during surgery, whereas 28.3% had >10 and 23% had <5 ligated veins. No statistically significant differences were noted in the initial or the follow-up results among the number of vein subgroups. Varicocele ligation improves patients' fertility potential. This improvement, however, is not influenced by the number of veins ligated intraoperatively. Clinical grading maintains its superiority in the evaluation of varicocele patients.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Urology, Hamad Medical Corporation, Doha, Qatar.
A
A
Majzoub
Department of Urology, Hamad Medical Corporation, Doha, Qatar.
H
H
Elbardisi
Department of Andrology, Cairo University, Cairo, Egypt.
M
M
Arafa
American Center for Reproductive Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
A
A
Agarwal
Department of Urology, Hamad Medical Corporation, Doha, Qatar.
S
S
Al Said
Department of Urology, Hamad Medical Corporation, Doha, Qatar.
K
K
Al Rumaihi
D000328:Adult; D004967:Estrogens / Q000097:blood*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood; D012189:Retrospective Studies; D012661:Semen; D055101:Semen Analysis; D013076:Sperm Count; D013081:Sperm Motility / Q000502:physiology; D013085:Spermatic Cord / Q000098:blood supply*; D013737:Testis / Q000098:blood supply*; D013739:Testosterone / Q000097:blood*; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*; D014680:Veins / Q000601:surgery*; D055815:Young Adult
D004967:Estrogens; D013739:Testosterone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
infertility; pampiniform plexus; semen analysis; varicocele