El-Shazly M, Eissa B
Department of Urology, Farwaniya Hospital, Ardiya, Kuwait.
Urol Int. 2013;91(2):192-6. doi: 10.1159/000350860. Epub 2013 Jul 6.
Varicocele affects up to 15% of men in the general population. In couples with subfertility, the prevalence of varicocele in male partners was about 12%. In certain countries like the Middle East and Arabian Gulf, it is not rare to find people in their 5th or 6th decades or even older, who are seeking infertility clinics wishing to achieve paternity.
What are the results of laparoscopic varicocelectomy in relatively older infertile men (>40 years) in comparison with young infertile men (<40 years)?
It is a prospective observational study done in Farwaniya Hospital, Kuwait. Patients (83 cases) were categorized into two age groups: group I (55 patients) with age ranging from 25 to 40 years, and group II (28 patients) with age >40 years (range 41-53 years). Cases with clinically detectable varicocele only were included (grade II and III). Cases who underwent varicocelectomy for pain were excluded from the study as well as cases with previous abdominal surgeries. Cases with subclinical and mild varicocele (grade I) were also excluded from the study. The intra- and postoperative parameters as well as the improvement in semen quality were compared in both groups. Patients were seen after 3 and 6 months as outpatients. Cases were followed up for a mean period of 1 year (range from 6 to 22 months).
The intraoperative and postoperative parameters as well as the improvement in semen quality were compared in both groups. There was colonic adhesion to the posterior peritoneum covering internal spermatic veins in 3 cases in group I (3.6%) and in 5 cases in group II (17.8%). This required more dissection to retract the colon and to expose the internal spermatic veins. The mean operative duration for laparoscopic varicocelectomy was significantly longer in group II (75 vs. 45 min in group I). After 3 months, 26 cases (47.2%) of group I and 11 cases (39.2%) of group II had improvement in semen quality. After 6 months, there was improvement in semen quality in 32 cases (58.2%) in group I and in 15 cases in group II (53.5%).
Laparoscopic varicocelectomy in relatively old men is sometimes more difficult technically with relatively longer operative duration. However, it can achieve improvement in semen quality comparable to relatively younger patients. Further randomized controlled trials are needed to draw a more relevant conclusion about the impact of age in the outcome of laparoscopic varicocelectomy.
精索静脉曲张在普通人群中影响着高达15%的男性。在不育夫妇中，男性伴侣精索静脉曲张的患病率约为12%。在中东和阿拉伯海湾等某些国家，不难发现五六十岁甚至更年长的人前往不孕不育诊所希望生育子女。
与年轻不育男性（<40岁）相比，相对年长的不育男性（>40岁）行腹腔镜精索静脉结扎术的结果如何？
这是一项在科威特法瓦尼亚医院进行的前瞻性观察性研究。患者（83例）被分为两个年龄组：第一组（55例）年龄在25至40岁之间，第二组（28例）年龄>40岁（范围为41 - 53岁）。仅纳入临床可检测到精索静脉曲张的病例（II级和III级）。因疼痛而行精索静脉结扎术的病例以及既往有腹部手术史的病例被排除在研究之外。亚临床和轻度精索静脉曲张（I级）病例也被排除在研究之外。比较两组的术中及术后参数以及精液质量的改善情况。患者在术后3个月和6个月作为门诊患者复诊。病例平均随访1年（范围为6至22个月）。
比较两组的术中及术后参数以及精液质量的改善情况。第一组有3例（3.6%）、第二组有5例（17.8%）出现结肠与覆盖精索内静脉的后腹膜粘连。这需要更多的解剖操作来牵开结肠并暴露精索内静脉。第二组腹腔镜精索静脉结扎术的平均手术时间明显更长（第一组为45分钟，第二组为75分钟）。3个月后，第一组26例（47.2%）、第二组11例（39.2%）的精液质量有所改善。6个月后，第一组32例（58.2%）、第二组15例（53.5%）的精液质量有所改善。
相对年长男性的腹腔镜精索静脉结扎术有时在技术上更困难，手术时间相对更长。然而，它能使精液质量得到与相对年轻患者相当的改善。需要进一步的随机对照试验来得出关于年龄对腹腔镜精索静脉结扎术结果影响的更相关结论。
