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Título

VEIN DIAMETER AS A PREDICTOR OF SEMEN ANALYSIS IMPROVEMENT AFTER MICROSURGICAL VARICOCELECTOMY

Resumo

INTRODUCTION: Varicocele is responsible for 35% of primary male infertility cases and found in 80% of men with secondary infertility. Varicocele is also considered the most common correctable cause of male infertility, and microsurgical varicocelectomy (MV) is its gold-standard treatment. However, there are no clear predictors of improvement in semen analysis (SA) after MV.
OBJECTIVE: We aimed to investigate if the varicocele diameter functions as a predictor for SA improvement after MV.
MATERIAL AND METHODS: We reviewed a database of infertile men submitted to MV by a single surgeon and identified 47 men who underwent left varicocelectomy as the only fertility treatment, and had preoperative SA and varicocele diameter measurement by color Doppler ultrasonography of the scrotum (CDUS) as well as postoperative SA data available. We defined improvement as an increase of more than 10% in the total progressive motile sperm count (TPMS), and we divided the men into 3 groups based on the largest varicocele diameter: < 3 mm (group 1) , 3 -4 mm (group 2), > 4 mm (group 3). Preoperative and intraoperative variables were compared between the groups.
RESULTS: Group 1 was composed by 11 (23%) men, group 2 by 24 (51%) men, and group 3 by 12 (26%) men. Group 1 had an improvement rate of 72%, group 2 of 83%, and group 3 of 58%. The groups showed statistically different improvements in TPMS after MV. Group 2 had the largest median improvement (18.3 ± 63.5 million/mL) despite having the lowest mean testosterone level (445 ± 141 ng/dL), whereas Group 1 and 3 had smaller improvements (3.8 ± 10.9 and 0.8 ± 4.9 million/mL respectively. Group 3 had the lowest mean participant age (27.8 ± 7.5 years), the highest median FSH level (7.7 ± 2.7 mUI/mL), and the lowest median LH level (5.0 ± 2.0 mUI/mL). There was also a trend to a smaller mean left testicular size for group 3.
CONCLUSION: Varicocele diameter measured by color Doppler ultrasonography seems to be a predictive factor for SA improvement after MV. Men with moderate size varicoceles benefit the most after MV. This can be explained by the lack of impact on spermatogenesis by small varicoceles, or extensive and irreparable damaged induced by large varicoceles.

Palavras Chave ( separado por ; )

Varicocele; Varicocelectomia; Ultrassonografia; Espermograma; Fertilidade