Kim E D, Leibman B B, Grinblat D M, Lipshultz L I
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
J Urol. 1999 Sep;162(3 Pt 1):737-40. doi: 10.1097/00005392-199909010-00031.
We analyzed the efficacy of varicocele repair in improving semen parameters in azoospermic men with spermatogenic failure.
After routine clinical evaluation with confirmatory pellet analysis testicular biopsy and varicocele repair were simultaneously performed in 28 azoospermic men with a primary diagnosis of unilateral or bilateral varicocele and spermatogenic failure. Semen analyses were obtained starting 4 months after varicocelectomy.
Repair was bilateral repair in 20 men and unilateral in 8. Of the 28 men 12 (43%) had sperm in the ejaculate with a mean postoperative sperm count plus or minus standard deviation of 1.2+/-3.6x10(6)/ml. and an average followup of 24 months. Mean sperm motility was 19+/-24% (range 0 to 80). Testicular biopsy was predictive of outcome. Only 9 men with severe hypospermatogenesis and 5 with maturation arrest spermatid stage had improvement in sperm density. No improvement was seen in 3 men with the Sertoli-cell-only pattern or 3 with maturation arrest spermatocyte stage. No pregnancies by natural intercourse resulted. One couple used fresh ejaculate for intracytoplasmic sperm injection and 1 underwent testicular sperm extraction with intracytoplasmic sperm injection. Both pregnancies resulted in live births. No other predictive factors were identified.
Varicocele repair can result in sperm in the ejaculate of azoospermic men when severe hypospermatogenesis or maturation arrest spermatid stage is present. Select men with spermatogenic failure and varicoceles may be candidates for varicocele repair, rather than resorting to testis biopsy for sperm extraction in preparation for intracytoplasmic sperm injection. However, the couple should be counseled that assisted reproductive technologies will most likely be required to initiate pregnancy.
我们分析了精索静脉曲张修复术对改善生精功能衰竭的无精子症男性精液参数的疗效。
在对28例初步诊断为单侧或双侧精索静脉曲张且生精功能衰竭的无精子症男性进行常规临床评估并经证实性睾丸活检后，同时进行精索静脉曲张修复术。精索静脉结扎术后4个月开始进行精液分析。
20例男性进行了双侧修复，8例进行了单侧修复。28例男性中，12例（43%）射精中有精子，术后平均精子计数±标准差为1.2±3.6x10(6)/ml，平均随访24个月。平均精子活力为19±24%（范围0至80）。睾丸活检可预测结果。只有9例严重精子发生低下和5例精子细胞阶段成熟停滞的男性精子密度有所改善。3例仅有支持细胞模式或3例精子母细胞阶段成熟停滞的男性未见改善。自然性交未导致妊娠。一对夫妇使用新鲜精液进行胞浆内单精子注射，1例接受睾丸精子提取并进行胞浆内单精子注射。两次妊娠均分娩活婴。未发现其他预测因素。
当存在严重精子发生低下或精子细胞阶段成熟停滞时，精索静脉曲张修复术可使无精子症男性射精中有精子。部分生精功能衰竭且患有精索静脉曲张的男性可能是精索静脉曲张修复术的候选者，而非为了准备胞浆内单精子注射而通过睾丸活检取精。然而，应向夫妇咨询，启动妊娠很可能需要辅助生殖技术。
