Ural OĞUZ, Ercan ÖĞREDEN, Erdal BENLİ, Abdullah ÇIRAKOĞLU, Erhan DEMİRELLİ, Orhan YALÇIN

Comparison of response to treatment of unilateral and bilateral varicocelectomy

Background/aim: We aimed to compare the results of unilateral and bilateral varicocele surgery. Materials and methods: In two referral hospitals, the data of 180 patients who were treated with unilateral and bilateral microscopic varicocelectomy were retrospectively analyzed. Sperm parameters and spontaneous pregnancy rates were compared in patients who underwent bilateral and unilateral microscopic varicocelectomy. Results: The mean age was 29.6 (17 46) years. While 82 patients underwent unilateral varicocelectomy (Group I), 98 patients underwent bilaterally varicocelectomy (Group II). Forty (48.8%) spontaneous pregnancies occurred in Group I and 59 (60.2%) in Group II. When we analyzed sperm parameters, the rate of increase in the number of sperm in spermiograms was 17% in Group I and 27.5% in Group II. The rate of increase in sperm mobility was 58.5% and 50% in Group I and II, respectively. The improvement rate in sperm morphology was 46.3% in Group I and 56.1% in Group II. There were no significant differences between all these parameters. Conclusion: In light of our results, although pregnancy rates seemed to be higher in patients who underwent bilateral varicocelectomy, these results were not statistically significant. Improvement rates in sperm parameters were similar between the patients who underwent unilateral and bilateral varicocelectomy

PDF

___

1. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril 1993; 59: 613-616.
2. Harrison RM, Lewis RW, Roberts JA. Pathophysiology of varicocele in nonhuman primates: long-term seminal and testicular changes. Fertil Steril 1986; 46: 500-510.
3. Lipshultz LI, Corriere JN Jr. Progressive testicular atrophy in the varicocele patient. J Urol 1977; 117: 175-176.
4. Vanlangenhove P, Dhondt E, Everaert K, Defreyne L. Pathophysiology, diagnosis and treatment of varicoceles: a review. Minerva Urol Nefrol 2014; 66: 257-282.
5. Pajovic B, Radojevic N, Dimitrovski A, Radovic M, Rolovic R, Vukovic M. Advantages of microsurgical varicocelectomy over conventional techniques. Eur Rev Med Pharmacol Sci 2015; 19: 532-538.
6. Ficarra V, Crestani A, Novara G, Mirone V. Varicocele repair for infertility: what is the evidence? Curr Opin Urol 2012; 22: 489-494.
7. Dohle GR, Colpi GM, Hargreave TB, Papp GK, Jungwirth A, Weidner W. EAU guidelines on male infertility. Eur Urol 2005; 48: 703-711.
8. Baazeem A, Belzile E, Ciampi A, Dohle G, Jarvi K, Salonia A, Weidner W, Zini A. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol 2011; 60: 796-808.
9. Lv JX, Wang LL, Wei XD, Zhang Z, Zheng TL, Huang YH, Zhou J, Xia F, Pu JX. Comparison of treatment outcomes of different spermatic vein ligation procedures in varicocele treatment. Am J Ther 2016; 23: e1329-e1334.
10. Pajovic B, Radojevic N, Dimitrovski A, Radovic M, Rolovic R, Vukovic M. Advantages of microsurgical varicocelectomy over conventional techniques. Eur Rev Med Pharmacol Sci 2015; 19: 532-538.
11. Zhang H, Liu XP, Yang XJ, Huang WT, Ruan XX, Xiao HJ, Li LY, Gao X, Zhang Y1. Loupe-assisted versus microscopic varicocelectomy: is there an intra operative anatomic difference? Asian J Androl 2014; 16: 112-114.
12. Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology 2000; 55: 750-754.
13. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol 1992; 148: 1808-1811.
14. Peng J, Long H, Yuan YM, Cui WS, Zhang ZC, Pan WB. Comparison of the outcomes of microscopic varicocelectomy and laparoscopic varicocelectomy. Beijing Da Xue Xue Bao 2014; 46: 541-543 (in Chinese with abstract in English).
15. Leung L, Ho KL, Tam PC, Yiu MK. Subinguinal microsurgical varicocelectomy for male factor subfertility: ten-year experience. Hong Kong Med J 2013; 19: 334-340.
16. Al-Said S, Al-Naimi A, Al-Ansari A, Younis N, Shamsodini A, A-Sadiq K, Shokeir AA. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol 2008; 180: 266-270.
17. Pan LJ, Pan F, Zhang XY, Liu Y, Zhang FL. Treatment of varicocele by microsurgical varicocelectomy: report of 94 cases. Zhonghua Nan Ke Xue 2012; 18: 416-418 (in Chinese with abstract in English).
18. Tarhan S, Gümüs B, Gündüz I, Ayyildiz V, Göktan C. Effect of varicocele on testicular artery blood flow in men-color Doppler investigation. Scand J Urol Nephrol 2003; 37: 38-42.
19. Ross JA, Watson NE, Jarow JP. The effect of varicoceles on testicular blood flow in man. Urology 1994; 44: 535-539.
20. European Association of Urology. Guidelines on Male Infertility. Arnhem, the Netherlands: EAO; 2015.
21. Miyaoka R, Esteves SC. A critical appraisal on the role of varicocele in male infertility. Adv Urol 2012; 2012: 597495.
22. Pasqualotto FF, Lucon AM, de Góes PM, Sobreiro BP, Hallak J, Pasqualotto EB, Arap S. Is it worthwhile to operate on subclinical right varicocele in patients with grade II-III varicocele in the left testicle? J Assist Reprod Genet 2005; 22: 227-231.
23. Scherr D, Goldstein M. Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles. J Urol 1999; 162: 85-88.
24. Libman J, Jarvi K, Lo K, Zini A. Beneficial effect of microsurgical varicocelectomy is superior for men with bilateral versus unilateral repair. J Urol 2006; 176: 2602-2605.
25. Grasso M, Lania C, Castelli M, Galli L, Rigatti P. Bilateral varicocele: impact of right spermatic vein ligation on fertility. J Urol 1995; 153: 1847-1848.
26. Fujisawa M, Ishikawa T, Takenaka A. The efficacy of bilateral varicocelectomy in patients with palpable bilateral varicoceles: comparative study with unilateral varicocele. Urol Res 2003; 31: 407-409.