Older Age Is Associated With Similar Improvements in Semen Parameters and Testosterone After Subinguinal Microsurgical Varicocelectomy

Hsiao, Wayland; Rosoff, James S.; Pale, Joseph R.; Greenwood, Eleni A.; Goldstein, Marc

doi:10.1016/j.juro.2010.09.114

Cited by 86 publications

(79 citation statements)

References 15 publications

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“…Total testosterone level increased significantly after varicocelectomy and the improvement in semen parameters was better in those patients with preoperative levels under 400 ng/dL. These results concur with those by Hsiao and colleagues, 18 while Kondo and colleagues concluded that low serum FSH and high testosterone significantly predicted improvements in semen parameters. 23 In a retrospective study of 202 patients, Rodriguez and colleagues did not find any significant predictive factors for improvement of the seminal fluid parameters.…”

Section: Varicocelectomy For Male Subfertilitysupporting

confidence: 84%

“…16,17 Hsiao and colleagues found that microsurgical varicocelectomy resulted in substantial changes in sperm concentration and sperm count in all studied groups, especially in men aged between 40 and 60 years. 18 Also in this study we noted no effect of patient age on the degree of improvement in postoperative semen parameters. Choi and colleagues noted that lower age of the patient at the time of varicocelectomy was correlated to enhancement of sperm motility.…”

Section: Varicocelectomy For Male Subfertilitymentioning

confidence: 41%

“…15 Many authors tried to define preoperative parameters as patient age, obesity, and semen parameters to help predict varicocelectomy outcome. [16][17][18][19] There is no literature regarding defined cut-off values for parameters that can predict a successful outcome of varicocelectomy on semen analysis. We aim to predict results of varicocelectomy on sperm density and progressive motility using preoperative clinical, laboratory and radiological data and to propose cut-off values for significant parameters.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study

Shabana

Teleb

Dawod

et al. 2015

CUAJ

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Introduction: We aim to predict results of varicocelectomy on sperm density and progressive motility using preoperative clinical, laboratory and radiological data and to propose cut-off values for significant parameters. Methods: This prospective study was carried out between July 2011 and June 2014. We included 123 patients in our study. They were diagnosed with primary infertility with varicocele, were scheduled for varicocelectomy, and completed their follow-up. We excluded patients with azoospermia, total necrospermia, recurrent varicocele, and pituitary hormonal abnormalities. Varicocele was diagnosed and graded by physical examination and colour Doppler ultrasound. Semen analyses were completed preoperatively and 6 months postoperatively. Microscopic subinguinal varicocelectomy was done in all cases. Patient demographics, pre-and postoperative clinical data (varicocele grade and semen parameters) were statistically analyzed. Results: The mean ± standard deviation of age, body mass index, and subfertility duration was 28.3 ± 7.4 years, 29.1 ± 2.7 kg/m 2 , and 21.9 ± 7.1 months, respectively. About 53% of our patients (n = 66) had bilateral varicocele, and unilateral disease was found in the other 57 (46.3%) cases. Varicocele grade I was diagnosed in 42 (34.1%) patients, while the other 81 (65.9%) patients had grade II or III. Higher grades of varicocele, preoperative total testosterone level, sperm density, and progressive motility had a statistically significant impact on the outcome of varicocelectomy in univariate testing. Multivariate logistic analysis revealed that grade of preoperative varicocele (95% confidence interval [CI] 5.6-6.3, p = 0.007) and sperm density (95% CI 2.7-1.6, p = 0.0035), and progressive motility (95% CI 1.1-2.3, p = 0.0123) are independent predictors of semen parameters improvement after varicocelectomy. Conclusion:The grade of the varicocele, sperm density, and progressive motility are major predictors of outcome in varicocelectomy. Cut-off values of >8 million/mL and >18% for sperm density and progressive motility, respectively, in men with varicocele grade II or III, indicate a successful outcome. IntroductionVaricocele is an abnormal enlargement and tortuosity of the pampiniform plexus of veins in the spermatic cord. It is the most common identifiable cause of male subfertility, with an estimated prevalence of 15% in the general male population and up to 40% in subfertile men.1 One of the theories of the varicocele influence on spermatogenesis is the resultant venous blood stagnation in the testis that increases oxidative stress and hinders spermatogenesis through a thermal effect. 2Varicocelectomy is by far the most common procedure to treat male subfertility in patients with clinical varicocele. It reduces intratesticular temperature to the normal range. Hence, semen parameters not uncommonly show significant improvement following varicocele ligation. There are many approaches for varicocelectomy. [4][5][6] Initially open surgical approach was the standard, but now...

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Section: Varicocelectomy For Male Subfertilitysupporting

confidence: 84%

Section: Varicocelectomy For Male Subfertilitymentioning

confidence: 41%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study

Shabana

Teleb

Dawod

et al. 2015

CUAJ

View full text Add to dashboard Cite

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“…Substantial controversy exists as to whether varicocelectomy is effective in older men, possibly due to irreversible testicular damage or limited potential for recovery from varicocele-induced damage [20]. To our knowledge, few studies are available in the literature reporting the impact of age on the outcome of open inguinal and subinguinal varicocelectomy [18,19,20].…”

Section: Discussionmentioning

confidence: 99%

“…They have shown that age is not a significant factor for outcomes of surgery. They concluded that it is reasonable to perform varicocele ligation to improve semen characteristics in patients >40 years [18,19,20]. …”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Varicocelectomy in Infertile Men: Does Age Matter?

El-Shazly

Eissa²

2013

Urol Int

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Introduction: Varicocele affects up to 15% of men in the general population. In couples with subfertility, the prevalence of varicocele in male partners was about 12%. In certain countries like the Middle East and Arabian Gulf, it is not rare to find people in their 5th or 6th decades or even older, who are seeking infertility clinics wishing to achieve paternity. Objectives: What are the results of laparoscopic varicocelectomy in relatively older infertile men (>40 years) in comparison with young infertile men (<40 years)? Methods: It is a prospective observational study done in Farwaniya Hospital, Kuwait. Patients (83 cases) were categorized into two age groups: group I (55 patients) with age ranging from 25 to 40 years, and group II (28 patients) with age >40 years (range 41-53 years). Cases with clinically detectable varicocele only were included (grade II and III). Cases who underwent varicocelectomy for pain were excluded from the study as well as cases with previous abdominal surgeries. Cases with subclinical and mild varicocele (grade I) were also excluded from the study. The intra- and postoperative parameters as well as the improvement in semen quality were compared in both groups. Patients were seen after 3 and 6 months as outpatients. Cases were followed up for a mean period of 1 year (range from 6 to 22 months). Results: The intraoperative and postoperative parameters as well as the improvement in semen quality were compared in both groups. There was colonic adhesion to the posterior peritoneum covering internal spermatic veins in 3 cases in group I (3.6%) and in 5 cases in group II (17.8%). This required more dissection to retract the colon and to expose the internal spermatic veins. The mean operative duration for laparoscopic varicocelectomy was significantly longer in group II (75 vs. 45 min in group I). After 3 months, 26 cases (47.2%) of group I and 11 cases (39.2%) of group II had improvement in semen quality. After 6 months, there was improvement in semen quality in 32 cases (58.2%) in group I and in 15 cases in group II (53.5%). Conclusions: Laparoscopic varicocelectomy in relatively old men is sometimes more difficult technically with relatively longer operative duration. However, it can achieve improvement in semen quality comparable to relatively younger patients. Further randomized controlled trials are needed to draw a more relevant conclusion about the impact of age in the outcome of laparoscopic varicocelectomy.

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