The effect untreated right subclinical varicocele on the outcomes of contralateral left clinical varicocelectomy in infertile patients
https://doi.org/10.4081/aiua.2023.12128
Accepted: December 5, 2023
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Purpose: The management of infertile patients with unilateral subclinical varicocele (SCV) and contralateral clinical varicocele (CV) remains controversial. We aimed to evaluate the effect of untreating SCV on the outcome of contralateral clinical varicocelectomy in infertile patients with oligoasthenozoospermia (OA). Materials and methods: Infertile patients with the diagnosis of OA who underwent left varicocelectomy were retrospectively evaluated. While all patients in the study had left clinical varicocele (LCV), some patients had concomitant right SCV. Patients were divided into two groups according to the presence or absence of a right SCV accompanying LCV as group 1; (LCV n = 104) or group 2; (LCV with right SCV, n = 74). Patients were evaluated with spermiogram parameters, pregnancy rates and serum levels of follicle stimulating hormone, luteinizing hormone, total testosterone at the first year of the follow-up. Results: The mean sperm concentration increased significantly in both groups. However, group 1 showed significantly greater improvement than group 2. The ratio of progressive motile sperm in group 1 was increased significantly whereas no significant change was shown in group 2. Both the spontaneous pregnancy rate and the pregnancy rate with ART were statistically lower in the group of patients with right SCV. No statistically significant difference was detected in serum hormone levels in both groups after varicocelectomy operations. Conclusions: Untreated right SCV may have adverse impact on the outcomes of left clinical varicocelectomy. In this context, the right testis can be considered in terms of treatment in patients with right SCV accompanying left CV.
Calverton, Maryland, USA: ORC Macro and the World Health Organization; 2004. World Health Organization. Infecundity, Infertility, and Childlessness in Developing Countries. DHS Comparative Reports No 9.
Sadock BJ, Sadock VA. 9th ed. Philadelphia: Lippincott Williams and Wilkins; 2003. Kaplans and Sadocks Symptoms of Psychiatry Behavioral Sciences Clinical Psychiatry; pp. 872-4.
Ficarra V, Cerruto MA, Liguori G, et al. Treatment of varicocele in subfertile men: The Cochrane review. A contrary opinion. European Urology. 2006; 49:258-263. DOI: https://doi.org/10.1016/j.eururo.2005.11.023
Kroese AC, De Lange NM, Collins J, Evers JL. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev. 2012; 10:CD000479.
Jarow JP. Effects of varicocele on male fertility. Hum Reprod Update. 2001; 7:59-64. DOI: https://doi.org/10.1093/humupd/7.1.59
Dhabuwala CB, Hamid S, Moghisi KS. Clinical versus subclinical varicocele: improvement in fertility after varicocelectomy Fertil Steril. 1992; 57:854-857. DOI: https://doi.org/10.1016/S0015-0282(16)54970-X
WHO, WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male. 2000, Cambridge University Press: Cambridge.
Lee J, Binsaleh S, Lo K, Jarvi K. Varicoceles: The diagnostic dilemma. J. Androl. 2008; 29:143-6. DOI: https://doi.org/10.2164/jandrol.107.003467
Niu Y, Wang D, Chan Y, et al. Comparison of clinical outcome of bilateral and unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: a meta-analysis of randomized controlled trials. Andrologia. 2018; 50:e13078.
Report on varicocele and infertility: A committee opinion. Practice Committee of the American Society for Reproductive Medicine; Society for Male Reproduction and Urology Fertil Steril. 2014; 102:1556-60. DOI: https://doi.org/10.1016/j.fertnstert.2014.10.007
Jungwirth A, Giwercman A, Tournaye H, et al. European Association of Urology Working Group on Male Infertility: the 2012 update. Eur Urol. 2012; 62:324-332. DOI: https://doi.org/10.1016/j.eururo.2012.04.048
Sun XL, Wang JL, Peng YP, et al. Bilateral is superior to unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: a prospective randomized controlled study. Int Urol Nephrol. 2018; 50:205-210.
Marsman JW, Schats R. The subclinical varicocele debate Hum Reprod.1994; 9:1-8. DOI: https://doi.org/10.1093/oxfordjournals.humrep.a138294
Cooper TG, Noonan E, Von Eckardstein S, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010; 16:231-45. DOI: https://doi.org/10.1093/humupd/dmp048
Tsampoukas G, Dellis A, Papatsoris A. Bilateral disease and intratesticular haemodynamics as markers of dyspermia in patients with subclinical varicocele: A prospective study. Arab J Urol. 2019; 17:298-304. DOI: https://doi.org/10.1080/2090598X.2019.1647676
Chiba K, Fujisawa M. Clinical outcomes of varicocele repair in infertile men: a review. World J Mens Health. 2016; 34:101-109. DOI: https://doi.org/10.5534/wjmh.2016.34.2.101
Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007; 88:639-648. DOI: https://doi.org/10.1016/j.fertnstert.2006.12.008
Dohle GR, Colpi GM, Hargreave TB, et al. EAU guidelines on male infertility. Eur Urol. 2005; 48:703-711. DOI: https://doi.org/10.1016/j.eururo.2005.06.002
Sharlip ID, Jarow JP, Belker AM, et al. Best practice policies for male infertility. Fertil Steril. 2002; 77:873-882. DOI: https://doi.org/10.1016/S0015-0282(02)03105-9
Scherr D, Goldstein M. Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles. J Urol. 1999; 162:85-88. DOI: https://doi.org/10.1097/00005392-199907000-00021
Unol D, Yeni E, Verit A, Karatas OF. Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: a prospective randomized study. Int J Urol. 2001; 8:227-30. DOI: https://doi.org/10.1046/j.1442-2042.2001.00289.x
McClure DR, Khoo D, Jarvi K, Hricak H. Subclinical varicocele: The effectiveness of varicocelectomy. J Urol. 1991; 145:789-791. DOI: https://doi.org/10.1016/S0022-5347(17)38452-5
Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. 1970;21:606-609. DOI: https://doi.org/10.1016/S0015-0282(16)37684-1
Chen SS. Significant predictive factors for subfertility in patients with subclinical varicocele. Andrologia. 2017; 49. DOI: https://doi.org/10.1111/and.12781
Cervellione RM, Corroppolo M, Bianchi, A. Subclinical varicocele in the pediatric age group. J Urol. 2008; 179:717-719. DOI: https://doi.org/10.1016/j.juro.2007.09.095
Marks JL, McMahonen R, Lipschultz LI. Predictive parameters of successful varicocele repair. J Urol. 1986; 136:609-612. DOI: https://doi.org/10.1016/S0022-5347(17)44990-1
Kroese AC, De Lange NM, Collins J, Evers JL. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev. 2012; CD000479. DOI: https://doi.org/10.1002/14651858.CD000479.pub5
Jarow JP, Ogle SR, Eskew LA. Seminal improvement following repair of ultrasound detected subclinical varicocele. J Urol. 1996; 155:1287-1290. DOI: https://doi.org/10.1016/S0022-5347(01)66245-1
Elbendary MA, Elbadry AM. Right subclinical varicocele: how to manage in infertile patients with clinical left varicocele? Fertil Steril. 2009; 92:2050-3. DOI: https://doi.org/10.1016/j.fertnstert.2009.05.069
Niu Y, Wang D, Chen Y, et al. Comparison of clinical outcome of bilateral and unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: A meta-analysis of randomised controlled trials. Andrologia. 2018; 50:e13078. DOI: https://doi.org/10.1111/and.13078
Sun XL, Wang JL, Peng YP, et al. Bilateral is superior to unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: a prospective randomized controlled study. Int Urol Nephrol. 2018; 50:205-10. DOI: https://doi.org/10.1007/s11255-017-1749-x
Almekaty KM, Elsharkawy AM, Zahran MH, et al. Bilaterality of varicocele: The overlooked culprit in male infertility. Case series study. Arch Ital Urol Androl. 2023; 95:11580. DOI: https://doi.org/10.4081/aiua.2023.11580
Grasso M, Lania C, Castelli M, et al. Bilateral varicocele impact of right spermatic vein ligation on fertility. J Urol. 1995; 153:1847-1848. DOI: https://doi.org/10.1016/S0022-5347(01)67327-0
Zini A, Buckspan M, Berardinucci D, Jarvi K. The influence of clinical and subclinical varicocele on testicular volume. Fertil Steril. 1997; 68:671-674. DOI: https://doi.org/10.1016/S0015-0282(97)00311-7
Pasqualotto FF, Lucon AM, De Góes PM, et al. 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. DOI: https://doi.org/10.1007/s10815-005-4926-2
Zheng YQ, Gao X, Li ZJ, et al. Efficacy of bilateral and left varicocelectomy in infertile men with left clinical and right subclinical varicoceles: A comparative study. Urology. 2009; 73:1236-1240. DOI: https://doi.org/10.1016/j.urology.2008.11.050
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