ERHAN ATEŞ, MURAT UÇAR, Mehmet Zeynel KESKİN, İlter ALKAN, AHMET GÖKÇE

Varikosel cerrahisinde klinik başarı oranlarını etkileyen faktörler

AMAÇ: Erkek infertilitesinin önemli sebeplerinden biri olan varikosel tedavisinde mikrocerrahi varikoselektomi altın standart teknik olarak kabul edilmektedir. Varikoselektominin semen parametrelerini iyileştirdiği bildirilse de, tüm raporlar bu bulguyu desteklememektedir. Bu nedenle hangi hastaların varikoselektomiden fayda görebileceğini öngörebilmek önem kazanmıştır. Bu çalışmada varikoselektomi başarısını öngörücü faktörleri belirlemeyi amaçladık.GEREÇ ve YÖNTEMLER: İnfertilite nedeniyle varikoselektomi uygulanmış 53 hastanın verileri retrospektif olarak değerlendirildi. Hastaların yaşı, infertilite süresi, vücut kitle indeksi gibi preoperatif demografik özellikler ile klinik bulgular kaydedildi. Preoperatif en az iki semen analizinden en yüksek total motil sperm sayısı olan, preoperatif değer olarak kabul edildi. Postoperatif 6. ayda kontrol semen analizindeki total motil sperm sayısında %50'den fazla artış ve total motil sperm sayısı 5 milyondan az olan hastalarda en az %100 artış olması anlamlı iyileşme olarak tanımlandı. Semen parametrelerinde iyileşme sağlananlar grup 1, sağlanmayanlar grup 2 olarak kategorize edildi.BULGULAR: İnfertilite süresi haricinde, iki gruptaki hastalar arasında preoperatif özelliklerde istatistiksel olarak anlamlı farklılık yoktu. Grup 1'deki preoperatif ve postoperatif tüm semen parametrelerindeki değişimler istatistiksel olarak anlamlı saptandı. Öte yandan grup 1 ve grup 2 arasında postoperatif semen parametrelerindeki değişim semen volümü haricinde istatistiksel olarak anlamlıydı. İnfertilite süresi, preoperatif sperm konsantrasyonu, total sperm sayısı ve total motil sperm sayısı istatistiksel anlamlı prediktör faktörler olarak saptandı.SONUÇ: Kısa infertilite süresi ve operasyon öncesi semen parametrelerinin iyi olması, varikoselektomiden elde edilecek başarıyı öngörmede belirleyici faktörlerdir

Factors affecting the clinical success rates of varicocele surgery

OBJECTIVE: Microsurgical varicocelectomy is accepted as the gold standard technique in treatment of varicocele which is one of the important reasons of male infertility. Although varicocelectomy has been reported to improve the semen parameters, not all reports support this finding. So, it is important to predict which patients will benefit from varicocelectomy. In this study, we aimed to determine the predictive factors of varicocelectomy success.MATERIAL and METHODS: The data of 53 patients who underwent varicocelectomy due to infertility were evaluated retrospectively. Clinical findings and preoperative demographic characteristics such as age of patient, duration of infertility, body mass index were recorded. The highest number of total motile sperm counts from at least 2 semen analyzes was accepted as the preoperative value. Significant improvement was defined as a 50% increase in the total motile sperm count or a minimum 100% increase in patients with less than 5 million total motile sperm counts in the postoperative 6th months control semen analysis. Patients were divided into two groups as improvement of semen parameters (group 1) and as ineffective group (group 2).RESULTS: There was no statistically significant difference in preoperative characteristics between two groups except the duration of infertility. Changes in preoperative and postoperative semen parameters in group 1 were statistically significant. Besides, the changes in postoperative semen parameters between group 1 and group 2 were statistically significant except for the semen volume. The duration of infertility, preoperative sperm concentration, total sperm count, and total motile sperm count were found to be statistically significant predictors.CONCLUSION: The short duration of infertility, and the preoperative good semen parameters are the predictive factors for the success of varicocelectomy

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