Urology Department of Tashkent Medical Academy; Republican Specialized Scientific-Practical Medical Center of Urology, Tashkent City.
Arch Ital Urol Androl. 2024 Feb 16;96(1):12082. doi: 10.4081/aiua.2024.12082.
Varicocele is the most common treatable cause of male infertility. The study aimed to compare varicocelectomy efficacy in men with primary (PI) and secondary infertility (SI).
Medical records of 100 men suffering from PI and SI and having varicocelectomy at the Republican Specialized Scientific-Practical Medical Center of Urology were retrospectively selected and analyzed. Patients were divided into 2 groups. Group I included 58 men with PI and Group II 42 men with SI. Preoperative clinical characteristics and semen parameters before and after varicocelectomy were analyzed and compared between groups.
Analysis revealed that the mean age of patients of group I was significantly lower (p<0.001) and the duration of infertility was accurately shorter (p<0.01) than those of group II. Main semen parameters increased significantly in group I (e.g., sperm concentration increased by 50%, from 62.2 ± 8.7 to 93.5 ± 10.0 M/ml, and total motile sperm count increased by 113%, from 76.7±17.1 to 163.4±27.8 M p<0.05), while in group II only rate of progressive motile sperm increased significantly (by 107%, from 13.5± .6 to 28.0±5.2% p<0.05). We identified a significant difference in varicocelectomy efficacy between group I and group II in change of total motile sperm count (by 113% vs 74% respectively, p<0.01). We also revealed a discrepancy between groups in correlation ratio (r) between initial and post-surgical percent of progressive motile sperm.
Patients with SI were older and had longer infertility period. Varicocelectomy resulted in significant semen parameters improvement in patients with PI. In patients with SI, only a percent of progressively motile sperm improved significantly. It indicates that advanced male age and long infertility duration may have a negative impact on varicocelectomy success.
精索静脉曲张是男性不育最常见的可治疗原因。本研究旨在比较原发性（PI）和继发性不育（SI）男性精索静脉结扎术的疗效。
回顾性选择并分析了在共和国内科泌尿科专门科学实践医学中心接受精索静脉结扎术的 100 名患有 PI 和 SI 的男性的病历。患者分为 2 组。第 I 组包括 58 名 PI 患者，第 II 组包括 42 名 SI 患者。分析并比较了两组患者术前临床特征和精索静脉结扎术前、后精液参数。
分析显示，第 I 组患者的平均年龄明显较低（p<0.001），不孕时间明显较短（p<0.01）。第 I 组主要精液参数显著增加（例如，精子浓度从 62.2±8.7 增加到 93.5±10.0 M/ml，增加了 50%，总活动精子数增加了 113%，从 76.7±17.1 增加到 163.4±27.8 M p<0.05），而第 II 组仅渐进性运动精子的比例显著增加（增加了 107%，从 13.5±.6 增加到 28.0±5.2% p<0.05）。我们发现第 I 组和第 II 组总活动精子数的精索静脉结扎术疗效有显著差异（分别增加了 113%和 74%，p<0.01）。我们还发现两组之间初始和手术后渐进性运动精子比例的相关系数（r）存在差异。
SI 患者年龄较大，不孕时间较长。精索静脉结扎术可显著改善 PI 患者的精液参数。在 SI 患者中，只有渐进性运动精子的比例显著改善。这表明男性年龄较大和不孕时间较长可能对精索静脉结扎术的成功产生负面影响。
