Varicocele Repair Improves Testicular Histology in Men with Nonobstructive Azoospermia

Abstract

Objective. To determine the histopathological differences after varicocele repair in testicular tissue in males with nonobstructive azoospermia. Methods. Between 2009 and 2014, 45 men with complete azoospermia and palpable varicocele, presenting with primary infertility of at least 1 year, undergoing varicocele repair at our institution were selected for the study. A standard systematic testicular 6-core Tru-Cut biopsy was performed during varicocele repair. Other biopsies were obtained from each testicle of all patients at the time of microscopic sperm extraction procedure. Results. Nineteen patients were selected for the study. Testicular biopsy specimens were classified as Sertoli cell only on preoperative histopathological analysis in 14 patients. After varicocele repair, focal spermatogenesis (n = 3) and late maturation arrest (n = 2) were found in these patients. Average Johnsen score was significantly increased after varicocelectomy (P = 0.003). Motile sperm was found in one patient on postoperative semen analyses and in 10 more patients in the microscopic sperm extraction procedure. Preoperative high serum follicle stimulating hormone level and venous reflux were significantly and negatively correlated with the increase in average Johnsen score (P < 0.05). Conclusions. Our findings suggest significant improvement in testicular histology after varicocele repair.

Evaluation of Normal and Varicocele‐Bearing Testes Using Real‐time Strain Elastography

“…7,17 In this study, the real-time strain elastographic parameters were significantly higher in the patients with varicocele than in the controls. This discrepancy may be related to the structural changes in testicular tissue associated with varicocele, 5,6 which is consistent with reports from other researchers, who reported significant differences between elastographic results of normal and varicocele-bearing testes. 14 In this study, no significant differences were found between the patient and control groups regarding testosterone and LH levels, which is in accordance with some researchers' findings 14,18 but not with those of others who reported an association with hypogonadism in their patients with varicocele.…”

“…An increased temperature of the testes could affect sperm cells either directly, resulting in a characteristic stress pattern with morphologically abnormal and sluggish sperm, as observed in our study, with some even proceeding to apoptosis, or indirectly, by inducing alterations in the testicular tissue structure with disorganized spermatogenesis . These structural alterations may have several forms . Histopathologic examinations of the testes were not performed in or included as a goal of this study.…”

“…[4][5][6] These pathologic changes represent one aspect of a complex multifactorial process affecting spermatogenesis in patients with varicocele. Screening of pathologic changes in the testes in men with varicocele may predict the outcomes of varicocele management, 5 which may be the most crucial step in developing a successful treatment strategy for an infertile man with varicocele. Screening can also provide insight into early damage to the testicular parenchyma in men with varicocele before it becomes critical, enabling determination of the optimal timing for varicocele intervention.…”

Testosterone and Gonadotropins in Infertile Men with Sertoli Cell Only Syndrome from Gaza Strip

“…3 Examples of causes of Sertoli cell only syndrome may include genetic factors, hormonal factors, idiopathic factors, varicocele, toxin exposure, history of radiation therapy, and history of severe trauma. [4][5][6] Endocrine malfunctions are more prevalent in infertile men than in the general population, but still quite uncommon. Abnormalities of the hypothalamic-pituitary-testicular axis at the testicular level cause primary testicular failure, whereas central defects of the hypothalamus or pituitary cause secondary testicular failure.…”

Does varicocelectomy improve semen in men with azoospermia and clinically palpable varicocele?

“…In terms of SCO, post‐varicocelectomy spermatozoon was recovered from the ejaculate of 3/25 (12%) of our SCO patients, in support of others who found motile spermatozoa in four of 10 SCO patients (Pasqualotto, Sobreiro, Hallak, Pasqualotto, & Lucon, ) and in one of 10 SCO patients (Lee et al, ). Two possible speculations might explain the detection of motile spermatozoa in SCO patients: nonproductive testicular tissue could improve after varicocelectomy and inactive germ cell precursors could be stimulated (Ustuner et al, ), or existing spermatogenesis may not have been detected during diagnostic testicular biopsy (Ustuner et al, ). As spermatogenesis may exhibit varying extents of maturation within a compromised testicle, hence, a single biopsy may not necessarily represent the most advanced histological pattern within a testis.…”