Bozhedomov V A, Shomarufov A B, Bozhedomova G E, D Ohobotov A, Kamalov D M, Sorokin N I, Kamalov A A
Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia.
Urologiia. 2021 May(2):62-68.
Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm.
to evaluate the standardized effect (Es) of nutrient therapy, microsurgical and laparoscopic varicocelectomy for pathozoospermia.
a multicenter case-control study with stratified randomization.
data of a clinical and laboratory examination of patients with clinical varicocele over a 3-month period in the groups: A) the observation/control group (n=33), B) the group treated with nutrients (n=63), C) the group of patients after microsurgical varicocelectomy with a subinguinal mini access (n=86), D) the group of patients following laparoscopic surgery (n=36). The ejaculate was evaluated according to WHO-2010, DNA fragmentation by chromatin dispersion in an agarose gel.
After 3 months, varicocelectomy leads to an increase in sperm concentration and motility: the median of the total number of progressively motile spermatozoa in the ejaculate in A is +0.4 million; B - +1.9 million; C - +17.1 million (p<0.05); D - +21.2 million (p<0.05). A clinically significant increase in this indicator after varicocelectomy was found in 2/3 of cases: 65% (B; p<0.05) and 67% (G; p<0.05) with 38% (A) and 42% (B). Varicocelectomy leads to a decrease in sperm DNA fragmentation by an average of 5.5% (p<0.05) with an improvement in 59% of patients, but a 3-month therapy with nutrients reduces DNA fragmentation in a similar way: 5.5% (p<0.05), 66% of improvement cases. The differences in effect between B and D are insignificant (p>0.05). The laparoscopic surgery demonstrated higher Es than microsurgical operation (Es=0.70 and 0.44, with 0.29 in the patient receiving nutrients and 0.22 in the patients in the control group) Conclusion Varicocelectomy significantly improves sperm quality in 2/3 of cases, including 5.5% decrease in DNA fragmentation. Nutrient therapy produces similar DNA fragmentation improvement. Further research is necessary to identify who really requires varicocelectomy and who does not.
精索静脉曲张并不总是导致不育；精索静脉结扎术也并不总是能改善精子质量。
评估营养疗法、显微外科和腹腔镜精索静脉结扎术对病理性精子症的标准化效果（Es）。
一项采用分层随机化的多中心病例对照研究。
收集临床精索静脉曲张患者在3个月期间的临床和实验室检查数据，分组如下：A）观察/对照组（n = 33）；B）营养治疗组（n = 63）；C）经腹股沟下小切口显微外科精索静脉结扎术后患者组（n = 86）；D）腹腔镜手术后患者组（n = 36）。根据世界卫生组织2010版标准评估精液，通过琼脂糖凝胶中的染色质分散法检测DNA碎片率。
3个月后，精索静脉结扎术可使精子浓度和活力增加：A组精液中进行性运动精子总数中位数增加0.4万；B组增加190万；C组增加1710万（p<0.05）；D组增加2120万（p<0.05）。在2/3的病例中发现精索静脉结扎术后该指标有临床显著增加：B组为65%（p<0.05），C组为67%（p<0.05），而A组为38%，B组为42%。精索静脉结扎术可使精子DNA碎片率平均降低5.5%（p<0.05），59%的患者得到改善，但3个月的营养疗法也能以类似方式降低DNA碎片率：降低5.5%（p<0.05），66%的病例得到改善。B组和D组的效果差异不显著（p>0.05）。腹腔镜手术显示出比显微外科手术更高的Es（Es分别为0.70和0.44，营养治疗组患者为0.29，对照组患者为0.22）。结论精索静脉结扎术在2/3的病例中可显著改善精子质量，包括DNA碎片率降低5.5%。营养疗法也能产生类似的DNA碎片率改善效果。有必要进一步研究以确定哪些人真正需要精索静脉结扎术，哪些人不需要。
