Andrological Section, Gynepro Medical Team, Bologna, Italy.
Department of Urology and Andrology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Andrology. 2019 Jan;7(1):62-68. doi: 10.1111/andr.12556. Epub 2018 Oct 24.
The existing classifications of varicocoeles have poor predictive value regarding the effects of surgery on sperm count.
To develop a new grading system for varicocoeles, useful as an indication for surgery.
This is a three-center prospective study which examined 173 men having clinically detectable left varicocoeles and oligo ± astheno ± terato-spermia. The patients underwent medical history collection, objective examination, duplex Doppler ultrasound scrotal examination, hormonal profiles, two semen analyses before surgery, and two semen analyses after surgery. Sperm concentration, motility, and morphology (standard semen parameters) were evaluated 6 months after surgery in function of the following preoperative variables: patient age, follicle-stimulating hormone, clinical grade of varicocoele, right and left testicular volume, extension of venous reflux, and semen parameters. The venous reflux was graded in two centers using duplex Doppler ultrasound: reflux visible only with Valsalva and continuous reflux. Spearman's rank semiquantitative analysis was used. All patients had their varicocoeles corrected according to the Colpi technique.
The variables capable of determining an improvement in semen parameters after varicocoele correction were in order of decreasing importance: venous reflux extent assessed by scrotal duplex Doppler ultrasound examination, varicocoele clinical grade, basal semen parameters, and follicle-stimulating hormone. Male age did not influence postoperative semen quality. Only patients with continuous reflux had their standard semen parameters improved after surgery.
Venous reflux extent is the most critical variable capable of predicting semen improvement after varicocoelectomy.
A correct duplex Doppler assessment of venous reflux is mandatory for predicting postoperative improvement of the sperm count.
现有的精索静脉曲张分类对于手术对精子计数的影响预测价值较低。
开发一种新的精索静脉曲张分级系统，作为手术适应证。
这是一项三中心前瞻性研究，共检查了 173 名患有临床可检测到的左侧精索静脉曲张和少精症±弱精症±畸形精子症的男性。患者接受了病史采集、体格检查、双功能多普勒超声阴囊检查、激素谱、手术前两次精液分析和手术后两次精液分析。术后 6 个月，根据以下术前变量评估精子浓度、活力和形态（标准精液参数）：患者年龄、卵泡刺激素、精索静脉曲张临床分级、左右睾丸体积、静脉反流程度和精液参数。在两个中心使用双功能多普勒超声评估静脉反流：仅在瓦尔萨尔瓦动作时可见的反流和持续反流。采用斯皮尔曼等级半定量分析。所有患者均根据科尔皮技术矫正精索静脉曲张。
能够确定精索静脉曲张矫正后精液参数改善的变量按重要性降序排列：通过阴囊双功能多普勒超声检查评估的静脉反流程度、精索静脉曲张临床分级、基础精液参数和卵泡刺激素。男性年龄不影响术后精液质量。只有持续反流的患者术后标准精液参数得到改善。
静脉反流程度是预测精索静脉曲张结扎术后精液改善的最关键变量。
正确的双功能多普勒静脉反流评估对于预测术后精子计数的改善是必需的。
