Wu Alex K, Walsh Thomas J, Phonsombat Surat, Croughan Mary S, Turek Paul J
Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94143-1695, USA.
Urology. 2008 Jun;71(6):1114-8. doi: 10.1016/j.urology.2007.12.074.
Varicocele is a common cause of infertility, and varicocele-associated testicular hypotrophy has been described as a potential cause of decreased semen quality. We investigated the relationship between testicular hypotrophy and poor semen quality in infertile men with varicoceles. We hypothesized that bilateral hypotrophy is required before the semen quality is severely impaired.
We retrospectively identified consecutive patients with palpable varicoceles undergoing an infertility evaluation at a single academic center. Each patient was evaluated by the same clinician with history and physical examination. Testicular hypotrophy was defined as a size discrepancy of greater than 3 mL or an absolute size of less than 14 mL. Multivariate logistic regression analysis was used to determine the clinical predictors of total motile sperm count (TMC) of less than 20 million.
A total of 245 men with complete data were identified, and 103 men with a TMC of less than 20 million sperm (mean age 36.2 +/- 6.6 years) were compared with 142 men with normal TMCs (mean age 37.1 +/- 6.5 years). On multivariate analysis, men with bilateral hypotrophy were nearly nine times more likely to have a TMC of less than 20 million sperm than were men without hypotrophy (odds ratio 8.8, 95% confidence interval 2.4 to 32.1), and six times more likely than those with unilateral hypotrophy (odds ratio 6.0, 95% confidence interval 1.4 to 26.3). Unilateral hypotrophy alone did not predict for a low TMC.
Among men with varicoceles undergoing infertility evaluation, those with bilateral hypotrophy are at the greatest risk of impaired semen quality.
精索静脉曲张是导致男性不育的常见原因，而精索静脉曲张相关的睾丸萎缩被认为是精液质量下降的一个潜在原因。我们研究了患有精索静脉曲张的不育男性中睾丸萎缩与精液质量差之间的关系。我们假设在精液质量严重受损之前需要双侧睾丸萎缩。
我们回顾性地确定了在单一学术中心接受不育评估且可触及精索静脉曲张的连续患者。每位患者均由同一位临床医生进行病史和体格检查评估。睾丸萎缩定义为两侧睾丸大小相差超过3 mL或睾丸绝对大小小于14 mL。采用多因素逻辑回归分析来确定总活动精子数（TMC）少于2000万的临床预测因素。
共确定了245名有完整数据的男性，将103名TMC少于2000万个精子的男性（平均年龄36.2±6.6岁）与142名TMC正常的男性（平均年龄37.1±6.5岁）进行比较。多因素分析显示，双侧睾丸萎缩的男性TMC少于2000万个精子的可能性是无睾丸萎缩男性的近9倍（比值比8.8，95%置信区间2.4至32.1），是单侧睾丸萎缩男性的6倍（比值比6.0，95%置信区间1.4至26.3）。单纯单侧睾丸萎缩并不能预测TMC低。
在接受不育评估的精索静脉曲张男性中，双侧睾丸萎缩者精液质量受损的风险最大。
