Shabana Waleed, Teleb Mohamed, Dawod Tamer, Elsayed Ehab, Desoky Esam, Shahin Ashraf, Eladl Mahmoud, Sorour Waleed
Faculty of Medicine, Zagazig University, Egypt.
Can Urol Assoc J. 2015 Sep-Oct;9(9-10):E579-82. doi: 10.5489/cuaj.2808. Epub 2015 Sep 9.
We aim to predict results of varicocelectomy on sperm density and progressive motility using preoperative clinical, laboratory and radiological data and to propose cut-off values for significant parameters.
This prospective study was carried out between July 2011 and June 2014. We included 123 patients in our study. They were diagnosed with primary infertility with varicocele, were scheduled for varicocelectomy, and completed their follow-up. We excluded patients with azoospermia, total necrospermia, recurrent varicocele, and pituitary hormonal abnormalities. Varicocele was diagnosed and graded by physical examination and colour Doppler ultrasound. Semen analyses were completed preoperatively and 6 months postoperatively. Microscopic subinguinal varicocelectomy was done in all cases. Patient demographics, pre- and postoperative clinical data (varicocele grade and semen parameters) were statistically analyzed.
The mean ± standard deviation of age, body mass index, and subfertility duration was 28.3 ± 7.4 years, 29.1 ± 2.7 kg/m(2), and 21.9 ± 7.1 months, respectively. About 53% of our patients (n = 66) had bilateral varicocele, and unilateral disease was found in the other 57 (46.3%) cases. Varicocele grade I was diagnosed in 42 (34.1%) patients, while the other 81 (65.9%) patients had grade II or III. Higher grades of varicocele, preoperative total testosterone level, sperm density, and progressive motility had a statistically significant impact on the outcome of varicocelectomy in univariate testing. Multivariate logistic analysis revealed that grade of preoperative varicocele (95% confidence interval [CI] 5.6-6.3, p = 0.007) and sperm density (95% CI 2.7-1.6, p = 0.0035), and progressive motility (95% CI 1.1-2.3, p = 0.0123) are independent predictors of semen parameters improvement after varicocelectomy.
The grade of the varicocele, sperm density, and progressive motility are major predictors of outcome in varicocelectomy. Cut-off values of >8 million/mL and >18% for sperm density and progressive motility, respectively, in men with varicocele grade II or III, indicate a successful outcome.
我们旨在利用术前临床、实验室及影像学数据预测精索静脉曲张手术对精子密度和前向运动能力的影响，并提出重要参数的临界值。
本前瞻性研究于2011年7月至2014年6月进行。我们纳入了123例患者。他们被诊断为原发性不育合并精索静脉曲张，计划接受精索静脉曲张手术，并完成了随访。我们排除了无精子症、完全死精子症、复发性精索静脉曲张及垂体激素异常的患者。通过体格检查和彩色多普勒超声诊断并分级精索静脉曲张。术前及术后6个月完成精液分析。所有病例均行显微镜下腹股沟下精索静脉曲张切除术。对患者的人口统计学资料、术前及术后临床数据（精索静脉曲张分级和精液参数）进行统计学分析。
年龄、体重指数和不育持续时间的平均值±标准差分别为28.3±7.4岁、29.1±2.7kg/m²和21.9±7.1个月。约53%的患者（n = 66）患有双侧精索静脉曲张，另外57例（46.3%）为单侧病变。42例（34.1%）患者诊断为精索静脉曲张I级，另外81例（65.9%）患者为II级或III级。在单因素检验中，精索静脉曲张的较高分级、术前总睾酮水平、精子密度和前向运动能力对精索静脉曲张手术的结果有统计学显著影响。多因素逻辑分析显示，术前精索静脉曲张分级（95%置信区间[CI]5.6 - 6.3，p = 0.007）、精子密度（95%CI 2.7 - 1.6，p = 0.0035）和前向运动能力（95%CI 1.1 - 2.3，p = 0.0123）是精索静脉曲张切除术后精液参数改善的独立预测因素。
精索静脉曲张分级、精子密度和前向运动能力是精索静脉曲张手术结果的主要预测因素。对于II级或III级精索静脉曲张患者，精子密度和前向运动能力的临界值分别>800万/mL和>18%，表明手术结果成功。
