Predictors of microsurgical varicocelectomy efficacy in male infertility treatment: critical assessment and systematization / 亚洲男科学杂志(英文版)

In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment. Regarding the outcomes of varicocele repair, we considered semen improvement and pregnancy and analyzed them separately. Based on the 2011 Oxford CEBM Levels of Evidence, we assigned a score to each trial that studied the role of the predictor. We systematized the studied predictors based on the total points, which were, in turn, calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant, into three levels of significance: predictors of high, moderate, and low clinical significance. Preoperative total motile sperm count (TMSC) coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy. In addition, for semen improvement alone, scrotal Doppler ultrasound (DUS) parameters, sperm DNA fragmentation index (DFI), and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.

Improvement in semen parameters after varicocoelectomy

Background: Varicoceles are associated with abnormal sperm parameters. The difference is more marked in cases with infertility and higher grades of varicocele. Following ligation of varicocele, there is a significant improvement in the sperm counts.Methods: The study was conducted in the department of general surgery at Maulana Azad Medical College and associated Lok Nayak Hospital from September 2012 to April 2014. The study was conducted on 40 numbers of patients. These were divided into 2 groups, group 1 (n=20) constituted of patients with varicocele who are symptomatic. Group 2 (n=20) constituted of patients with varicocele who are asymptomatic (infertile). All patients were evaluated by clinical examination and Doppler to grade the varicocele. All patients underwent detailed semen analysis. Patients of both the groups underwent FNAC of bilateral testes. The patients with clinical or Doppler detectable varicocele were taken up for low ligation of varicocele. Patients were followed up and all above parameters were repeated about 3 months after surgery.Results: The sperm morphology, counts and motility increase significantly in group 2 patients and sperm counts and morphology increased significantly in group 1 while motility not increased significantly.Conclusions: Most of the patients who presented to us were in the age group of 25-35 years. Longer duration of disease in patient with infertility is also suggestive of the fact that varicocele is a progressive disease and leads to testicular dysfunction over time leading to infertility. Most of the varicoceles were either left sided or bilateral

Benefit of varicocelectomy in infertile men with varicocele

Background: Varicocelectomy does improve semen parameters and pregnancy rates in men with infertility. Various studies have shown the extent of benefit and also shown that some may not benefit. It is important to counsel the patients about the same. The present study was done to determine how much varicocelectomy is beneficial to infertile men with varicocele.Methods: A prospective observational cohort study was conducted on 25 patients undergoing varicocelectomy for infertility at St. John Medical College Hospital, Bangalore from 1st June 2013 to 31st May 2014. Clinical data, semen analysis, scrotal imaging was done and postoperatively semen analysis was done after three months. The data was analysed to find out how much was the benefit of varicocelectomy.Results: Twenty-five patients underwent varicocelectomy, all of them showed improvement of semen parameters. Fifteen of them had more than 50% of improvement. This showed that varicocelectomy is beneficial to about 60% of patients.Conclusions: Varicocelectomy is beneficial to infertile men with palpable varicocele and abnormal semen parameters.

A Study of the Surgical Outcome and Impact on Semen Parameters after Laparoscopic Varicocelectomy and Sub Inguinal Varicocelectomy

Varicocele is the dilatation of pampiniform plexuses which can cause infertility. Incidence of varicocele is around 15-80 % and remains the most common treatable cause of infertility in men. The aim of this study was to identify the preferred method of varicocelectomy in patients with infertility, which gives optimal improvement in semen parameters. This study compares laparoscopic varicocelectomy and subinguinal varicocelectomy.METHODSThis is a prospective interventional study carried out in the Department of Urology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai from August 2017 to July 2019. We included patients with documented infertility with clinical varicocele. Only couples with no other attributable causes including female factors for infertility were included. Patients with previous history of surgery for inguinal hernia, testicular pathology were excluded from the study. We included 25 patients who satisfied the inclusion criteria. They were subjected to physical examination, doppler study and semen analysis. The patients were randomised into 2 groups, A & B by random allocation. Group A (12 patients) underwent laparoscopic varicocelectomy and group B (13 patients) underwent subinguinal varicocelectomy. All patients were regularly followed up at 3 months and 6 months period post-surgery.RESULTSReview at immediate post-operative period, follow ups at 3 & 6 months were undertaken. History of conception, clinical examination, semen analysis according to WHO 2010 manual and doppler studies by Sarchetsi scale were performed. Three factors in seminal parameters namely sperm concentration, motility & morphology were assessed. Varicocele recurrence was also assessed. There had been a statistically significant improvement in semen parameters in all the patients who underwent varicocelectomy (p value p< 0.005). On comparing the laparoscopic and sub-inguinal surgical techniques, there was no significant variation in increase in sperm concentration, sperm motility and morphology.CONCLUSIONSVaricocelectomy improves the semen parameters. No significant variation was observed when the different surgical approaches of varicocelectomy were compared.

Laparoscopic Versus Open High Ligation for Adolescent Varicocele: A 6-year Single Center Study

Objective: The aim of this study was to compare the outcomes of high ligation in adolescentswith varicocele between open and laparoscopic surgical approaches. Design: Retrospectivestudy. Setting: The study was conducted from January 2012 to January 2018, with medianfollow-up of 36 months, in the division of pediatric surgery at tertiary-care hospital. Patients:Data of 537 adolescents who underwent varicocelectomy were classified into two groups,depending on surgical approach. Intervention: Open or laparoscopic varicocelectomy. Mainoutcome measures: Indications for surgery, complications, duration of surgery, hospitalstay, and recurrences rate. Results: The median age of the patients was 15 years. Themedian (IQR) duration of surgery was 12 (11,15.3) min in laparoscopic and 25 (10,30) min inopen group (P<0.001). The most common complication was hydrocele (n=29), which wasmore common in open group (6.8% vs 1.4%; P=0.01). A total of 16 recurrences wererecorded, all in open group (P=0.049). In both groups, sperm concentration (P<0.001),morphology (P<0.001) and motility (laparoscopy, P=0.001; P=0.02; open varicocelectomy,P=0.001; P=0.04) improved six months after surgery in patients with varicocele stage I and II.In stage III there was an improvement in sperm concentration (P=0.002; P=0.001) andmorphology (P=0.03; P=0.06), while sperm motility (P=0.15; P=0.2) did not significantlyrecover in either of the groups. Conclusions: Laparoscopic and open varicocelectomy areequally effective and result in significant improvement of testicular volume, disappearance ofpain, and sperm parameters in adolescents. Based on our findings laparoscopicvaricocelectomy is associated with shorter operating time, shorter hospitalization, fasterrecovery, and fewer complications and recurrences

Prevalence of anti-sperm antibodies, risk factors associated and their impact on spermatobioscopy in infertile men

Background: The first immunological correlation with male infertility was reported in 1954 by Wilson and Rumke with the identification of anti-sperm antibodies. The prevalence of anti-sperm antibodies in infertile men varies from 9%-36%, the main cause being the loss of the blood-testicular barrier and otherwise the association with chronic inflammation. It has been shown that immune infertility is found in 15% of patients with varicocele.Methods: A transversal comparative study was carried out with 360 infertile men who were tested for anti-sperm antibodies between January 2011 and July 2018. Two groups were integrated; Group 1, infertile men with positive anti-sperm antibodies >50%, group 2, infertile men with negative anti-sperm <50%. Seminogram parameters were evaluated according to the WHO 5th edition and associated risk factors with anti-sperm antibodies.Results: 360 infertile men were evaluated during the study, 42 were excluded because they did not meet the inclusion criteria, the prevalence of anti-sperm antibodies was 14.5%. Group 1; n=46 (14.5%) and group 2, n=272 (85.5%), the clinical characteristics and the hormonal profile were compared at study admission without significant difference. There was a significant decrease in progressive motility in group 1 (38.7±23.8) vs group 2 (50.1±18.9) p=0.03. Analyzing the risk factors, varicocele was found to be significant 23.7%, OR 2.14 (1.27-3.61) p=0.004 as well as retractable testicle 26.4%, OR 2.13 (1.23-3.70) p= 0.008.Conclusions: The affectation of motility was confirmed, which leads to the suspect varicocele and retractable testicle as risk factors.

Hypogonadism is independently associated with varicocele repair in a contemporary cohort of men in the USA / 亚洲男科学杂志(英文版)

We aimed to identify demographic and clinical predictors of varicocele repair in a contemporary cohort of men in the USA. We queried the 2009-2015 MarketScan Database using relevant ICD9, ICD10, and CPT codes to identify all 18-45 year olds with varicoceles. Differences in age, area of residence, clinical characteristics, and medical management between men who did and did not undergo varicocelectomy (open, laparoscopic, or microsurgical) during the study period were compared using unpaired t-Tests and Chi-squared tests for continuous and categorical variables, respectively. Multivariable logistic regression analysis was used to evaluate age, semen analyses, and serum hormone assessment as predictors of varicocele repair. SAS version 9.4 was used for all statistical analyses. Significance was set at P < 0.05. Approximately 40% of men with varicoceles underwent repair, primarily through an open approach. Men who underwent repair were more likely to have a diagnosis of male infertility (15.5% vs 7.9%, P < 0.001) and male hypogonadism (3.4% vs 0.9%) and were more likely to complete semen analyses (36.1% vs 12.2%, P < 0.001) and serum testosterone evaluation (42.5% vs 18.8%, P < 0.001). In multivariable regression models, the strongest predictors of varicocele repair were semen analysis (OR = 2.78, 95% CI: 2.56-3.02), age 18-25 years (OR = 2.66, 95% CI: 2.36-2.98), and serum testosterone evaluation (OR = 1.67, 95% CI: 1.51-1.86). Although male infertility remains the most important indication for varicocele repair, male hypogonadism is emerging as an independent predictor of varicocelectomy, which may represent a change in the clinical management of varicoceles in the USA.

Microsurgical subinguinal varicocelectomy with delivery of the testis and ligation of gubernacular veins: Evaluation of clinical effects / 中华男科学杂志

<p><b>Objective</b>To compare the clinical effects and postoperative complications of microsurgical subinguinal varicocelectomy (MSV) with or without delivery of the testis and ligation of gubernacular veins in the treatment of varicocele.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 163 varicocele patients treated by MSV, 40 with (group A) and the other 123 without delivery of the testis and ligation of gubernacular veins (group B). We compared the operation time, postoperative complications, rate of recurrence, and semen parameters before and at 3 months after surgery between the two groups of patients.</p><p><b>RESULTS</b>The operation time was significantly longer in group A than in B (［81.1 ± 20.0］ vs ［62.3 ± 9.6］ min, P = 0.041). Sperm concentration, total sperm count per ejaculate, sperm viability, and the percentage of progressively motile sperm were significantly improved in both groups at 3 months after MSV as compared with the baseline (P < 0.05). There were no statistically significant differences in the above semen parameters between the two groups of patients with grade Ⅲ varicocele before and after surgery (P < 0.05). Scrotal edema developed in 5 cases in group A and wound infection in 2 cases in group B after MSV, but no postoperative testicular atrophy or recurrence was observed in either of the two groups.</p><p><b>CONCLUSIONS</b>MSV with delivery of the testis and ligation of gubernacular veins showed no advantages over that without in reducing varicocele recurrence and improving semen parameters, but rather involved longer operation time and a higher incidence rate of postoperative complications.</p>

A retrospective review of single-institution outcomes with robotic-assisted microsurgical varicocelectomy / 亚洲男科学杂志(英文版)

We report the largest single-center experience with robotic-assisted microscopic varicocelectomy (RAMV) in male infertility. From August 2012 to February 2015, men with infertility of at least a year and varicoceles underwent RAMV by a single surgeon. Varicocele was diagnosed on physical examination and confirmed by ultrasound by a single ultrasonographer. Preoperative hormone panel, semen analyses, and testicular Doppler ultrasound were obtained from all men and repeated at 3 months. One hundred and forty consecutive men (258 varicocelectomies) were included. Mean age and duration of infertility was 36.4 and 2.8 years, respectively. Median total and free testosterone increased by 145 ng dl-1 and 4.3 pcg ml-1 (44.3%), respectively (P < 0.0001). Median sperm concentration increased by 37.3% (P < 0.03). Median sperm motility and morphology did not significantly change. Median left and right testicular volume increased by 22.3% (P < 0.0001) and 12.6% (P < 0.0006), respectively. Hydroceles occurred 0.8% of procedures. We had no testicular artery injuries. Persistence of varicocele by Doppler ultrasound was 9.6%. Only 37.3% of patients required pain medications postoperatively. We concluded that RAMV is a safe and effective alternative for varicocele repair with outcomes comparable to historical traditional microsurgical approach.

Seminal plasma miR-192a: A biomarker predicting successful resolution of nonobstructive azoospermia following varicocele repair / 亚洲男科学杂志(英文版)

This study was performed to investigate a potential marker for the presence of spermatozoa in the ejaculate following varicocelectomy in Chinese men with nonobstructive azoospermia and varicoceles. The micro-RNA (miR)-192a levels in seminal plasma and testicular tissue were evaluated by quantitative real-time polymerase chain reaction from 60 men with nonobstructive azoospermia and varicoceles (Group A: 27 men with spermatozoa found in the ejaculate after surgery; Group B: 33 men without spermatozoa found in the ejaculate after surgery) and 30 controls. The seminal plasma and testicular tissue miR-192a levels were higher in Group B than in Group A and the controls (P 0.05). Apoptosis and proliferation assays with miR mimics and inhibitors showed that miR-192a induced GC-2 cell apoptosis through the activation of Caspase-3 protein. Thus, seminal plasma miR-192a appears to be a potential marker for successfully indicating spermatozoa in the ejaculate following microsurgical varicocelectomy in men with nonobstructive azoospermia and varicoceles. Seminal plasma miR-192a may be a useful clinical marker for prescreening to determine which patients with nonobstructive azoospermia and varicoceles would benefit from varicocelectomy.

Microsurgical subinguinal varicocelectomy-technique and preliminary results

INTRODUCTION@#Varicoceles represent the most common attributable cause of primary and secondaryinfertility in the male. A number of studies have established the effect of performing varicocelectomyin order to improve semen parameters. Several techniques of varicocelectomy has been described inliterature, however, the microsurgical technique has been considered as the gold standard in doingthis procedure.@*OBJECTIVES@#The study primarily aims to establish the effect of microsurgical varicocelectomy onpostoperative semenalysis when compared to baseline semenalysis. It also aimed to establish theimpregnation rate and the span at which impregnation occurs following varicocelectomy. Lastly, thestudy also describes the technique and modifications of microsurgical subinguinal varicoelectomyperformed by a single surgeon using an operating microscope and microdoppler throughout theprocedure.@*MATERIALS AND METHODS@#Microsurgical subinguinal varicocelectomy was performed on 37 patients inSLMC from June 2015 to May 2017 by a single microsurgeon (DGL). Patient age, varicocele grade,operative time, intraoperative findings, postoperative complication, and 3-month follow-upsemenalysis results were recorded and compared. Successful impregnation of the partner and thenumber of months from the operation to the successful impregnation were also recorded.@*RESULTS@#Three months postoperative semenalysis parameters were compared to the baselinesemenalysis. The total sperm motility was noted to have increased from 27.95± 15.02 to 50.95±12.60,postoperatively with p-value of 0.010. There was no significant difference observed in the totalcount, concentration, and percent immature forms. Eleven or 30% of patients were able tosuccessfully impregnate their partners in an average span of 9 months from the time of surgery.@*CONCLUSION@#In their experience, Microsurgical subinguinal varicocelectomy has improved the semenanalysis after 3 months with a 30% chance of impregnation at an average span of 9 months,postoperatively. Furthermore, the use of microdoppler ultrasound in microsurgical varicocelectomyfacilitated better identification of the testicular arteries.

Factors influencing the postoperative resolution of varicocele-associated scrotal pain / 中华男科学杂志

Objective@#To investigate the factors influencing the postoperative resolution of varicocele-associated scrotal pain.@*METHODS@#Using the keywords "varicocele", "testicular pain", "scrotal pain", "painful varicocele", "ligation", and "varicocelectomy", we searched the PubMed, Embase, Cochrane Collaboration's Database, CNKI, Wanfang, and VIP Database up to October 2016 for the studies relating to surgical treatment of varicocele-associated scrotal pain. We assessed the quality of the cohort studies included using the Newcastle-Ottawa Scale and that of the randomized controlled trials included with the Cochrane Collaboration's tool. We conducted a meta-analysis using the RevMan software.@*RESULTS@#Finally 14 studies were included in this meta-analysis, of which, 2 involved the history of disease, 8 involved the nature of pain, 2 involved the intensity of pain, 9 involved the grade of varicocele, 3 involved the side of varicocele, 9 involved surgical approaches, 3 involved surgical techniques, and 4 involved postoperative recurrence. The pain resolution rate was significantly higher after subinguinal ligation than after high or inguinal ligation (RR = 0.82, 95% CI: 0.76－0.89, P <0.01; RR = 0.92, 95% CI: 0.86－0.99, P = 0.02), and so was it after microsurgery than after laparoscopic varicocelectomy (RR = 0.77, 95% CI: 0.60－0.99, P = 0.04).@*CONCLUSIONS@#Subinguinal varicocelectomy and microsurgery are more effective options than laparoscopic and high or trans-inguinal ligation of the spermatic vein for resolution of varicocele-associated scrotal pain, while the history of disease, the nature and intensity of pain, the grade and side of varicocele, or postoperative recurrence cannot be regarded as the influencing factors.

Laparoscopic extraperitoneal high ligation of the spermatic vein for the treatment of varicocele / 中华男科学杂志

Objective@#To investigate the effect of laparoscopic extraperitoneal (LSEP) high ligation of the spermatic vein in the treatment of varicocele.@*METHODS@#We retrospectively analyzed the clinical data about 80 cases of varieocele, 48 treated by LSEP and the other 32 by laparoscopic transabdominal retroperitoneal (LSTR) high ligation of the spermatic vein. We recorded the semen parameters before and at 1, 3 and 6 months after surgery, intraoperative blood loss, operation time, postoperative complications, time of gastrointestinal function recovery and rate of pregnancy, followed by comparison of the data obtained between the two groups of patients.@*RESULTS@#Semen parameters were remarkably improved in both the LSEP and LSTR groups of patients postoperatively as compared with the baseline (P 0.05). The intraoperative blood loss was less in the LSEP than in the LSTR group (［8.3 ± 5.2］ vs ［9.1 ± 6.1］ ml, P >0.05), the operation time was shorter in the former than in the latter (［38.27 ± 9.23］ vs ［43.46 ± 11.72］ min, P >0.05), and so was the time of gastrointestinal function recovery (［1.27 ± 0.26］ vs ［2.43 ± 0.41］ d, P 0.05).@*CONCLUSIONS@#Laparoscopic extraperitoneal high ligation of the spermatic vein is safe and effective and has the advantage of quick recovery in the treatment of varicocele.

Comparison of surgical effect and postoperative patient experience between laparoendoscopic single-site and conventional laparoscopic varicocelectomy: A systematic review and meta-analysis / 亚洲男科学杂志(英文版)

The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy (LESSV) and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design (RCT and non-RCT). The odds ratio (OR) or standardized mean difference (SMD) and their 95% confidence intervals (95% CIs) were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work (overall: SMD = -1.454, 95% CI: -2.502-0.405, P = 0.007; non-RCT: SMD = -2.906, 95% CI: -3.796-2.017, P = 0.000; and RCT: SMD = -0.841, 95% CI: -1.393-0.289, P = 0.003) and less pain experience at 3 h or 6 h (SMD = -0.447, 95% CI: -0.754-0.139, P = 0.004), day 1 (SMD = -0.477, 95% CI: -0.905-0.05, P = 0.029), and day 2 (SMD = -0.612, 95% CI: -1.099-0.125, P = 0.014) postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect (improvement of semen quality and scrotal pain relief), and complications (hydrocele and recurrence) yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.

Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation / 亚洲男科学杂志(英文版)

We have established a novel method named transumbilical two-port laparoscopic varicocele ligation (TTLVL) for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades II-III according to the Dubin grading system were randomly assigned to TTLVL (n = 45) and conventional laparoscopic varicocele ligation (CLVL) (n = 45). The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups (P > 0.05). However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL (P = 0.001, 0.010, 0.006, and 0.027, respectively). The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group (P < 0.001). There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes.

The application of laparoscopic Doppler ultrasound during laparoscopic varicocelectomy in infertile men / 亚洲男科学杂志(英文版)

The aim of this study is to evaluate the benefits of laparoscopic Doppler ultrasound (LDU) application during laparoscopic varicocelectomy (LV), and to compare the surgical outcomes and complications between LDU-assisted LV (LDU-LV) and conventional LV for infertile patients with varicoceles; 147 infertile patients were randomly divided into two groups. Operative and postoperative parameters, semen parameters, and the pregnancy rate were compared. There were no differences in baseline demographics. The operative time was significantly longer in LDU-LV group than LV group. The incidence of postoperative hydrocele was 1.4% (1/72) in LDU-LV group versus 10.7% (8/75) in LV group, which showed a significant difference (P 0.05). In conclusion, compared with LV, LDU-LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele. Given the benefits that sperm counts as well as sperm motility favoring LDU-LV, we recommend that LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.

Computer-aided sperm analysis: A useful tool to evaluate patient's response to varicocelectomy / 亚洲男科学杂志(英文版)

Preoperative and postoperative sperm parameter values from infertile men with varicocele were analyzed by computer-aided sperm analysis (CASA) to assess if sperm characteristics improved after varicocelectomy. Semen samples of men with proven fertility (n = 38) and men with varicocele-related infertility (n = 61) were also analyzed. Conventional semen analysis was performed according to WHO (2010) criteria and a CASA system was employed to assess kinetic parameters and sperm concentration. Seminal parameters values in the fertile group were very far above from those of the patients, either before or after surgery. No significant improvement in the percentage normal sperm morphology (P = 0.10), sperm concentration (P = 0.52), total sperm count (P = 0.76), subjective motility (%) (P = 0.97) nor kinematics (P = 0.30) was observed after varicocelectomy when all groups were compared. Neither was significant improvement found in percentage normal sperm morphology (P = 0.91), sperm concentration (P = 0.10), total sperm count (P = 0.89) or percentage motility (P = 0.77) after varicocelectomy in paired comparisons of preoperative and postoperative data. Analysis of paired samples revealed that the total sperm count (P = 0.01) and most sperm kinetic parameters: curvilinear velocity (P = 0.002), straight-line velocity (P = 0.0004), average path velocity (P = 0.0005), linearity (P = 0.02), and wobble (P = 0.006) improved after surgery. CASA offers the potential for accurate quantitative assessment of each patient's response to varicocelectomy.

Laparoscopic varicocelectomy now the gold standard procedure for varicocele – A comparative study with open technique based on our experience

Background: The link between varicocele and infertility was first reported by cessius in 1st century AD but it was not widely acknowledged until TULLOCH and colleagues reported the improvement of sperm parameters in 26 of 30 patients undergoing varicocelectomy. Varicocele is defined as excessive dilatation of pampiniform venous plexus of spermatic cord. varicocele is an important cause infertility which can be corrected by surgery. Several methods have been used for its treatment including open surgical ligation of spermatic veins as well as laparoscopic varicocelectomy. Open varicocelectomy has more risk of recurrence and complications whereas laparoscopic varicocelectomy is simple, has less risk of recurrence and complication in expert hands. Objectives: To compare Laparoscopic varicocelectomy with open varicocelectomy, in terms of postoperative pain, recurrence rate, hospital stay, cost, cosmetic and complication. To prove hospital stay was more in open group than laparoscopic group and also patient of laparoscopic group return to normal activities earlier than open group. To standardize the laparoscopic varicocelectomy procedure for varicocele. Materials and methods: It was a randomized clinical trial done in Department of General Surgery, Vinayaka Mission Medical College, Karaikal. Study was carried out from 1 st March, 2015 to 1st R. Bharathidasan, Reny Jayaprakash, Subith P. Bhaskar, G. Ambujam. Laparoscopic varicocelectomy now the gold standard procedure for varicocele - A comparative study with open technique based on our experience. IAIM, 2017; 4(7): 218-221. Page 219 March, 2016. A total 70 patients was taken in our study of its 36 patient undergone open varicocelectomy and 34 patient undergone laparoscopic varicocelectomy. Results: Recurrence rate 0% in Laparoscopic Varicocelectomy and 5.6% in open varicocelectomy. Wound complication was 0% in Laparoscopic varicocelectomy and 2.5% in open varicocelectomy. Post-operative pain was more in open group as compared to laparoscopic varicocelectomy. Laparoscopic varicocelectomy has less post-operative morbidity and early return to normal activity. Also there was improvement in seminal analysis in both groups. Conclusion: We would like to standardize laparoscopic varicocoelectomy and make it as a gold standard for Varicocele by replacing open technique provided there is good experienced surgical team and good instrumentation. Cost of the procedure is comparatively high.

Critical appraisal of conventional semen analysis in the context of varicocele / 亚洲男科学杂志(英文版)

Varicocele is present in approximately 15% of men, and, although it is the most commonly diagnosed cause of male infertility, nearly two-thirds of men with varicoceles remain fertile. It was decided to make use of the current evidence obtained from the previous meta-analyses between 2004 and 2015 as well as available articles covering this field, preferably randomized controlled articles dealing with the topic of semen analysis before and after repair. Two important meta-analyses were discussed as well as other articles dealing with the topic of semen analysis before and after varicocelectomy. The evidence suggests that all semen parameters improve after varicocele repair. Based on the available evidence, it is clear that there is a benefit in treating men with a palpable varicocele. One can expect that all semen parameters will improve within 3 months after repair.

Outcome of assisted reproductive technology in men with treated and untreated varicocele: Systematic review and meta-analysis / 亚洲男科学杂志(英文版)

Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxidative stress and sperm DNA fragmentation, and increases the chances of natural conception. However, it is unclear whether performing varicocelectomy in men with clinical varicocele prior to assisted reproductive technology (ART) improve treatment outcomes. The objective of this study was to evaluate the role of varicocelectomy on ART pregnancy outcomes in nonazoospermic infertile men with clinical varicocele. An electronic search was performed to collect all evidence that fitted our eligibility criteria using the MEDLINE and EMBASE databases until April 2015. Four retrospective studies were included, all of which involved intracytoplasmic sperm injection (ICSI), and accounted for 870 cycles (438 subjected to ICSI with prior varicocelectomy, and 432 without prior varicocelectomy). There was a significant increase in the clinical pregnancy rates (OR = 1.59, 95% CI: 1.19-2.12, I2 = 25%) and live birth rates (OR = 2.17, 95% CI: 1.55-3.06, I2 = 0%) in the varicocelectomy group compared to the group subjected to ICSI without previous varicocelectomy. Our results indicate that performing varicocelectomy in patients with clinical varicocele prior to ICSI is associated with improved pregnancy outcomes.