Lehtihet Mikael, Arver Stefan, Kalin Bo, Kvist Ulrik, Pousette Ake
Department of Medicine/Huddinge, Karolinska Institutet and Centre for Andrology and Sexual Medicine, Karolinska University Hospital , Stockholm , Sweden.
Scand J Urol. 2014 Jun;48(3):284-9. doi: 10.3109/21681805.2013.868513. Epub 2013 Dec 19.
Varicocele is present in approximately 30-40% of men evaluated for infertility and in 10-20% of the general male population, but the association between varicocele, compromised semen quality and male infertility remains unclear. This indicates that varicocele may impair spermatogenesis or in some other way mitigate sperm quality. Better understanding of criteria for the selection of men who will benefit from varicocele repair would improve the clinical management of men with impaired semen quality and varicocele.
To further understand the effect of varicocele repair by embolization in men with grade 3 varicocele, 50 men referred for infertility with varicocele were evaluated before and after embolization.
There was a significant improvement in total sperm count (25.5 ± 4.7 million to 78 ± 11 million, p < 0.001) and sperm motility (slowly and rapidly progressive) (31.5 ± 2.9% to 45 ± 2.5%, p < 0.001) after spermatic vein embolization, comparing baseline to 3 month post-treatment follow-up data. Furthermore, alpha-glucosidase (specific epididymis-derived protein) increased from 61.7 ± 5.7 U to 84.7 ± 7.0 U (p < 0.05) and sperm droplets decreased from 14.2 ± 1.5% to 11.0 ± 1.0% (p < 0.05).
The results indicate improved epididymal function and suggest that left-sided grade 3 varicocele may affect the epididymis in addition to effects on the testis.
在因不育接受评估的男性中，约30%-40%存在精索静脉曲张，在普通男性人群中这一比例为10%-20%，但精索静脉曲张、精液质量受损与男性不育之间的关联仍不明确。这表明精索静脉曲张可能损害精子发生或以其他方式降低精子质量。更好地理解选择能从精索静脉曲张修复中获益的男性的标准，将改善精液质量受损且患有精索静脉曲张男性的临床管理。
为进一步了解栓塞治疗对3级精索静脉曲张男性的修复效果，对50名因精索静脉曲张导致不育前来就诊的男性在栓塞治疗前后进行了评估。
对比基线数据与治疗后3个月随访数据，精索静脉栓塞后，精子总数（从2550±470万提高到7800±1100万，p<0.001）和精子活力（缓慢和快速前向运动）（从31.5±2.9%提高到45±2.5%，p<0.001）有显著改善。此外，α-葡萄糖苷酶（特定的附睾衍生蛋白）从61.7±5.7 U增加到84.7±7.0 U（p<0.05），精子凝集率从14.2±1.5%下降到11.0±1.0%（p<0.05）。
结果表明附睾功能得到改善，并提示左侧3级精索静脉曲张除了影响睾丸外，可能还会影响附睾。
