Greenberg Daniel R, Hudnall Matthew T, Goyette Bailey N, Fantus Richard J, Dubin Justin M, Brannigan Robert E, Halpern Joshua A
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA.
Department of Urology, University of Missouri, Columbia, USA.
Cureus. 2023 Sep 11;15(9):e45061. doi: 10.7759/cureus.45061. eCollection 2023 Sep.
Objective Varicocele is considered the most common reversible cause of male infertility. However, some men do not clinically improve after surgical repair. We aimed to identify preoperative factors associated with decreased semen parameters and clinical "downgrading" of total motile sperm count (TMSC) following varicocelectomy. Methods We examined men with preoperative laboratory testing and pre- and postoperative semen analyses (SA) who underwent varicocelectomy between 2010 and 2020. Ejaculate volume, sperm motility, sperm concentration, TMSC, and clinical grade of TMSC (in vitro fertilization: <5M sperm, intrauterine insemination: 5-9M sperm, natural pregnancy: >9M sperm) were used to determine postoperative outcomes. Demographic and clinical factors were compared between cohorts. Results Among 101 men who underwent varicocelectomy, 35 (34.7%) had decreased postoperative TMSC with a median follow-up of 6.6 months (interquartile range 3.9-13.6 months). Eleven (10.9%) men experienced TMSC clinical "downgrading" following surgery. Clinical grade III varicocele was significantly associated with decreased sperm motility on postoperative SA (OR 4.1, 95% CI 1.7-10.0, p=0.002), and larger left testicle volume (OR 1.4, 95% CI 1.1-1.8, p=0.02) was associated with clinical "downgrading" after varicocelectomy. Conclusion A small but significant proportion of men experienced a "downgrading" of semen parameters after varicocelectomy. Larger left testis size was associated with clinical downgrading, whereas clinical grade III varicoceles were associated with lower post-treatment sperm motility. These data are critical for preoperative patient counseling.
目的 精索静脉曲张被认为是男性不育最常见的可逆性病因。然而，一些男性在手术修复后临床症状并未改善。我们旨在确定与精索静脉曲张切除术后精液参数降低以及总活动精子数（TMSC）临床“降级”相关的术前因素。方法 我们对2010年至2020年间接受精索静脉曲张切除术的男性进行了术前实验室检查以及术前和术后精液分析（SA）。射精量、精子活力、精子浓度、TMSC以及TMSC的临床分级（体外受精：<500万精子，宫内人工授精：500 - 900万精子，自然受孕：>900万精子）用于确定术后结果。对不同队列的人口统计学和临床因素进行比较。结果 在101例行精索静脉曲张切除术的男性中，35例（34.7%）术后TMSC降低，中位随访时间为6.6个月（四分位间距3.9 - 13.6个月）。11例（10.9%）男性术后出现TMSC临床“降级”。临床III级精索静脉曲张与术后SA时精子活力降低显著相关（OR 4.1，95%CI 1.7 - 10.0，p = 0.002），而左侧睾丸体积较大（OR 1.4，95%CI 1.1 - 1.8，p = 0.02）与精索静脉曲张切除术后临床“降级”相关。结论 一小部分但比例显著的男性在精索静脉曲张切除术后精液参数出现“降级”。左侧睾丸体积较大与临床降级相关，而临床III级精索静脉曲张与治疗后精子活力较低相关。这些数据对于术前患者咨询至关重要。
