Shamsa Ali, Nademi M, Aqaee M, Fard A Nouraee, Molaei Mahmood
Department of Urology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Saudi J Kidney Dis Transpl. 2010 Nov;21(6):1100-5.
Varicocele is still an enigma. Its effects on semen analysis, fertility and, more recently, early ejaculation and spontaneous abortion in spouses are not yet fully understood. In this retrospective study, we evaluated these four parameters (semen analysis, fertility, early ejaculation and spontaneous abortion among spouses) in relation to varicocele and varicocelectomy during a 13-year period. A total of 1,711 patients with varicocele underwent varicocelectomy by high inguinal method (251 cases), subinguinal method (1,375 cases), scrotal method (34 cases), and subinguinal method with local anesthesia (38 cases). Our complication rate was acceptable. Sperm count, motility and morphology increased three months post operation in 55, 51, and 46%, respectively (P value 0.000, 0.000, and 0.015, respectively). Paternity was 56% after one year of post varicocelectomy follow-up. Only 7 out of 82 azoospermic men had sperm in their semen after varicocelectomy and only one of them with mild spermatogenic hypoplasia became a father. The spontaneous abortion rate in the spouses of respondents was 59%. Early ejaculation improved in 75% of the respondents. In conclusion, varicocelectomy does not improve sperm parameters in all men, but it improves pregnancy rate, early ejaculation, and scrotal pain.
精索静脉曲张仍是一个谜。其对精液分析、生育能力的影响，以及最近对配偶早泄和自然流产的影响尚未完全明确。在这项回顾性研究中，我们在13年的时间里评估了这四个参数（精液分析、生育能力、早泄和配偶自然流产）与精索静脉曲张及精索静脉结扎术的关系。共有1711例精索静脉曲张患者接受了高位腹股沟法（251例）、腹股沟下法（1375例）、阴囊法（34例）和局部麻醉腹股沟下法（38例）的精索静脉结扎术。我们的并发症发生率是可以接受的。术后三个月，精子数量、活力和形态分别有55%、51%和46%的改善（P值分别为0.000、0.000和0.015）。精索静脉结扎术后一年的受孕率为56%。82例无精子症男性中，只有7例在精索静脉结扎术后精液中有精子，其中只有1例轻度生精发育不全者成为父亲。受访者配偶的自然流产率为59%。75%的受访者早泄情况有所改善。总之，精索静脉结扎术并非对所有男性的精子参数都有改善作用，但它能提高妊娠率、改善早泄和阴囊疼痛。
