Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy : which subfertile patients benefit from surgery?
Palmisano, Franco (University of Milan, Milan, Italy)
Moreno-Mendoza, Daniel (Institut d'Investigació Biomèdica Sant Pau)
Ievoli, Riccardo (University of Bologna, Bologna, Italy)
Veber-Moisés-Da Silva, Gabriel (Institut d'Investigació Biomèdica Sant Pau)
Gasanz, Carlos (Institut d'Investigació Biomèdica Sant Pau)
Villegas-Osorio, Juan Fernando (Institut d'Investigació Biomèdica Sant Pau)
Peraza-Godoy, Maria Fernanda (Institut d'Investigació Biomèdica Sant Pau)
Vives, Álvaro (Institut d'Investigació Biomèdica Sant Pau)
Bassas, Lluís (Institut d'Investigació Biomèdica Sant Pau)
Montanari, Emanuele (University of Milan, Milan, Italy)
Ruiz-Castañé, Eduardo (Institut d'Investigació Biomèdica Sant Pau)
Sarquella-Geli, Joaquim (Institut d'Investigació Biomèdica Sant Pau)
Sánchez-Curbelo, Josvany (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	The exact mechanism of varicocele-related infertility is still elusive, therefore, the current challenges for its management lie in determining which patients stand to benefit most from surgical correction. The authors aimed to assess the clinical factors affecting semen improvement after left microsurgical subinguinal varicocelectomy (MSV) in relation to patient age, ultrasound varicocele grading (USVG), and presence of a right subclinical varicocele (RSV). From 2010 to 2017 a total of 228 infertile patients underwent left MSV for clinical varicocele. Descriptive statistics were used to describe the cohort and verify the surgical benefit in terms of semen improvement, in addition, subsets of patients were selected according to clinical covariates. Logistic regression modeling was applied to evaluate the presence of RSV, operative time, age, and USVG as explanatory variables. Sperm concentration (SC), progressive sperm motility (PSM), and normal sperm morphology (NSM) increased significantly after surgery (p = 0. 002; p = 0. 011; p = 0. 024; respectively). Mean SC improved after MSV in ⩾35 year-old patients and the grade 3 USVG group (p = 0. 01; p = 0. 02; respectively). Logistic regression modeling showed a that the probability of SC improvement was 76% lower in subjects presenting RSV (p = 0. 011). In addition, patients with a grade 3 USVG presented a three-times greater probability of SC improvement compared with patients with a lower USVG (p = 0. 035). In addition, older patients showed a greater probability of SC improvement after MSV (p = 0. 041). MSV is an effective varicocele-related infertility treatment that should also be offered to older patients. In addition, patients with a higher USVG benefit from surgery. In infertile men with an RSV in association with a left clinical disease, a bilateral varicocele repair should be considered.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Age ; Grade ; Infertility ; Microsurgery ; Predictors ; Semen parameters ; Subclinical ; Ultrasound ; Varicocele ; Varicocelectomy
Published in:	Therapeutic Advances in Urology, Vol. 11 (november 2019) , ISSN 1756-2880

DOI: 10.1177/1756287219887656
PMID: 31741684

11 p, 1.2 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles