Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: which subfertile patients benefit from surgery?

Franco Palmisano, Daniel Moreno-Mendoza, Riccardo Ievoli, Gabriel Veber-Moisés-Da Silva, Carlos Gasanz-Serrano, Juan Fernando Villegas-Osorio, Maria Fernanda Peraza-Godoy, Álvaro Vives, Lluís Bassas, Emanuele Montanari, Eduard Ruiz-Castañé, Joaquim Sarquella-Geli, Josvany Sánchez-Curbelo

Research output: Contribution to journalArticle

Abstract

Background: 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). Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish
Article numbere3332
JournalTherapeutic Advances in Urology
Volume18
Issue number9
DOIs
Publication statusPublished - Jan 1 2019

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Varicocele
Semen
Spermatozoa
Infertility
Logistic Models
Sperm Motility
Operative Time

Keywords

  • age
  • grade
  • infertility
  • microsurgery
  • predictors
  • semen parameters
  • subclinical
  • ultrasound
  • varicocele
  • varicocelectomy

ASJC Scopus subject areas

  • Urology

Cite this

Palmisano, F., Moreno-Mendoza, D., Ievoli, R., Veber-Moisés-Da Silva, G., Gasanz-Serrano, C., Villegas-Osorio, J. F., ... Sánchez-Curbelo, J. (2019). Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: which subfertile patients benefit from surgery? Therapeutic Advances in Urology, 18(9), [e3332]. https://doi.org/10.1177/1756287219887656

Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy : which subfertile patients benefit from surgery? / Palmisano, Franco; Moreno-Mendoza, Daniel; Ievoli, Riccardo; Veber-Moisés-Da Silva, Gabriel; Gasanz-Serrano, Carlos; Villegas-Osorio, Juan Fernando; Peraza-Godoy, Maria Fernanda; Vives, Álvaro; Bassas, Lluís; Montanari, Emanuele; Ruiz-Castañé, Eduard; Sarquella-Geli, Joaquim; Sánchez-Curbelo, Josvany.

In: Therapeutic Advances in Urology, Vol. 18, No. 9, e3332, 01.01.2019.

Research output: Contribution to journalArticle

Palmisano, F, Moreno-Mendoza, D, Ievoli, R, Veber-Moisés-Da Silva, G, Gasanz-Serrano, C, Villegas-Osorio, JF, Peraza-Godoy, MF, Vives, Á, Bassas, L, Montanari, E, Ruiz-Castañé, E, Sarquella-Geli, J & Sánchez-Curbelo, J 2019, 'Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: which subfertile patients benefit from surgery?', Therapeutic Advances in Urology, vol. 18, no. 9, e3332. https://doi.org/10.1177/1756287219887656
Palmisano, Franco ; Moreno-Mendoza, Daniel ; Ievoli, Riccardo ; Veber-Moisés-Da Silva, Gabriel ; Gasanz-Serrano, Carlos ; Villegas-Osorio, Juan Fernando ; Peraza-Godoy, Maria Fernanda ; Vives, Álvaro ; Bassas, Lluís ; Montanari, Emanuele ; Ruiz-Castañé, Eduard ; Sarquella-Geli, Joaquim ; Sánchez-Curbelo, Josvany. / Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy : which subfertile patients benefit from surgery?. In: Therapeutic Advances in Urology. 2019 ; Vol. 18, No. 9.
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abstract = "Background: 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). Methods: 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. Results: 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). Conclusions: 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.",
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T2 - which subfertile patients benefit from surgery?

AU - Palmisano, Franco

AU - Moreno-Mendoza, Daniel

AU - Ievoli, Riccardo

AU - Veber-Moisés-Da Silva, Gabriel

AU - Gasanz-Serrano, Carlos

AU - Villegas-Osorio, Juan Fernando

AU - Peraza-Godoy, Maria Fernanda

AU - Vives, Álvaro

AU - Bassas, Lluís

AU - Montanari, Emanuele

AU - Ruiz-Castañé, Eduard

AU - Sarquella-Geli, Joaquim

AU - Sánchez-Curbelo, Josvany

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N2 - Background: 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). Methods: 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. Results: 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). Conclusions: 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.

AB - Background: 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). Methods: 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. Results: 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). Conclusions: 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.

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KW - semen parameters

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