Arafa Mohamed M, Majzoub Ahmad A, El Ansari Walid A, AlMalki Ahmad H, Mahdi Mohammed Y, Khalafalla Kareim M, AlKubaisi Khalid J, AlSaid Sami S, ElBardisi Haitham T
Department of Urology, Hamad Medical Corporation, Doha, Qatar.
Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar.
Asian J Urol. 2025 Apr;12(2):267-274. doi: 10.1016/j.ajur.2024.08.001. Epub 2024 Sep 27.
This study investigated the outcomes of microsurgical subinguinal varicocelectomy (MSV) on semen and hormonal parameters in cases with isolated sperm defects (oligozoospermia, asthenozoospermia, or teratozoospermia).
A retrospective review of charts of patients who underwent MSV for clinically palpable varicocele between January 1, 2011 and January 1, 2019 at Hamad Medical Corporation was undertaken. All patients diagnosed with isolated oligozoospermia, asthenozoospermia, or teratozoospermia in the preoperative semen analysis were included. Men with multiple sperm defects, genetic abnormalities, azoospermia, history of genitourinary infection, exposure to chemotherapy or radiotherapy, or prior use of peri-operative fertility treatment were excluded. Data extracted from the electronic medical records included (collected before MSV and up to 6 months postoperatively): demographics (age), clinical data (fertility-related medical history and surgical interventions), family history (consanguinity and infertility), physical examination findings from general and local genital exam (varicocele side and grade), laboratory data such as semen analysis, sperm DNA fragmentation tests, and hormone levels (follicle-stimulating hormone, luteinizing hormone, total testosterone, estradiol, and prolactin), and imaging (scrotal color Doppler ultrasound).
A total of 331 patients with isolated sperm defects were included. Postoperatively, 83.3% of patients showed an improvement in sperm concentration with a median increase of 7 millions/mL. Postoperatively, 76.7% of isolated asthenozoospermic patients showed an improvement in total motility and 66.0% had an improvement in progressive motility with median increases of 15.0% and 7.5%, respectively. Postoperatively, 70.0% of the teratozoospermic patients showed an improvement in normal sperm morphology with a median increase of 6%. No changes were observed in other semen or hormone parameters that were examined.
MSV is a valid and effective treatment modality for patients with isolated sperm defects that significantly corrects their respective semen abnormality and improves their chances of natural conception.
本研究调查了显微外科腹股沟下精索静脉结扎术（MSV）对单纯精子缺陷（少精子症、弱精子症或畸形精子症）患者精液和激素参数的影响。
对2011年1月1日至2019年1月1日在哈马德医疗公司因临床可触及的精索静脉曲张接受MSV手术的患者病历进行回顾性分析。纳入所有术前精液分析诊断为单纯少精子症、弱精子症或畸形精子症的患者。排除有多种精子缺陷、遗传异常、无精子症、泌尿生殖系统感染史、接触化疗或放疗史或术前曾使用生育治疗的男性。从电子病历中提取的数据包括（MSV术前及术后6个月收集）：人口统计学数据（年龄）、临床数据（生育相关病史和手术干预）、家族史（近亲结婚和不孕）、全身及局部生殖器检查的体格检查结果（精索静脉曲张侧别和分级）、实验室数据如精液分析、精子DNA碎片检测和激素水平（促卵泡激素、促黄体生成素、总睾酮、雌二醇和催乳素）以及影像学检查（阴囊彩色多普勒超声）。
共纳入331例单纯精子缺陷患者。术后，83.3%的患者精子浓度有所改善，中位数增加700万/mL。术后，76.7%的单纯弱精子症患者总活力有所改善，66.0%的患者前向运动能力有所改善，中位数分别增加15.0%和7.5%。术后，70.0%的畸形精子症患者正常精子形态有所改善，中位数增加6%。所检查的其他精液或激素参数未观察到变化。
MSV是治疗单纯精子缺陷患者的一种有效治疗方式，可显著纠正其各自的精液异常并提高自然受孕几率。
