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 language | English |
|---|---|
| Article number | e3332 |
| Journal | Therapeutic Advances in Urology |
| Volume | 18 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - Jan 1 2019 |
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Keywords
- age
- grade
- infertility
- microsurgery
- predictors
- semen parameters
- subclinical
- ultrasound
- varicocele
- varicocelectomy
ASJC Scopus subject areas
- Urology
Cite this
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 journal › Article
}
TY - JOUR
T1 - Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy
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
PY - 2019/1/1
Y1 - 2019/1/1
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.
KW - age
KW - grade
KW - infertility
KW - microsurgery
KW - predictors
KW - semen parameters
KW - subclinical
KW - ultrasound
KW - varicocele
KW - varicocelectomy
UR - http://www.scopus.com/inward/record.url?scp=85074690700&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85074690700&partnerID=8YFLogxK
U2 - 10.1177/1756287219887656
DO - 10.1177/1756287219887656
M3 - Article
AN - SCOPUS:85074690700
VL - 18
JO - Therapeutic Advances in Urology
JF - Therapeutic Advances in Urology
SN - 1756-2872
IS - 9
M1 - e3332
ER -