Efficacy of spermatic vein ligation in patients affected by high grade left varicocele

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Purpose: To study the effect of high grade varicocele treatment in infertile patients. Materials and Methods: Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility--related disease; no obvious causes of infertility in the subject's partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period. Results: Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple). The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012). Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10 6 /mL compared to 19.7x10 6 /mL in the postoperative period (p < 0.0001). Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001). Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001). Conclusion: Surgical treatment of high grade varicocele proved to effectively treat associated infertility by improving seminal parameters and pregnancy rate in our patient cohort.

Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion

“…Medicine ® OPEN (EDV), and vascular resistance index (RI) in gonadal vessels upon Doppler ultrasound examination (US). [18][19][20][21][22][23][24][25][26][27][28][29][30] On the other hand, only a few publications describe changes in echostructure, vascular flow, or gonadal volume in boys with TT. [2,4,5,10,16,31] Therefore, we have undertaken research to explain the following issues.…”

“…There are many publications discussing the results of treatment of various diseases of the testicular region, including measurements of peak-systolic velocity (PSV), end-diastolic velocity (EDV), and vascular resistance index (RI) in gonadal vessels upon Doppler ultrasound examination (US) [18–30] . On the other hand, only a few publications describe changes in echostructure, vascular flow, or gonadal volume in boys with TT [2,4,5,10,16,31] …”

The Role of Varicocele Grade on Seminal Fluid Parameters Post Varicocelectomy : Experience at Prince Hussein Urology Centre

“…Grasso et al showed that 42.5% of infertile couples got pregnant following varicocele surgery with a significantly higher rate in the first postoperative period. (27) , while Ghanaie et al showed that varicocele repair not only improves pregnancy rate compared to expectant management 44.1% to 19.1% respectively, but also significantly decreased miscarriage rates. (28)…”

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

“…The surgical effect of grade 1 patients was inferior to that of grade 2–3 patients ( Asafu-Adjei et al, 2020 ). Some studies also suggest that surgery is more statistically significant for patients with higher grades of varicocele ( Vahidi et al, 2018 ), and high-grade left varicocele surgery is more effective ( Grasso et al, 2014 ). In our study, we also found unexpected and similar results.…”