https://doi.org/10.4081/aiua.2025.13938
The changes of semen parameters of patients with clinical versus subclinical varicocele managed by laparoscopic varicocelectomy: observational study
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 30 June 2025
Objectives: To assess the effectiveness of laparoscopic varicocelectomy in patients with clinical versus subclinical varicocele concerning preoperative and postoperative seminal parameters.
Patients and methods: Between February 2021 and August 2024, a total of 162 patients diagnosed with varicocele (72 with subclinical and 90 with clinical presentation) seeking infertility advice (primary or secondary) at the author's institution underwent laparoscopic varicocelectomy and were enrolled in the study. All patients underwent history taking, clinical examination, semen analysis, and scrotal colour Doppler ultrasonography. Patients with recurrent varicocele, azoospermia, or infertility due to causes other than varicocele were excluded from the study. Semen analysis was conducted for all patients before laparoscopic varicocelectomy and 3 to 6 months after varicocelectomy.
Results: Significant improvements in seminal parameters were observed in patients with clinical varicocele (p < 0.05). Bilateral and right-sided varicoceles were more prevalent in patients with subclinical varicocele. Additionally, the incidence of secondary infertility was higher in patients with subclinical varicocele compared to those with clinical varicocele (p<0.05).
Conclusions: Our study indicates favourable outcomes of laparoscopic varicocelectomy in patients with clinical varicocele. Regarding the effects of varicocelectomy in patients with subclinical varicocele, we recommend avoiding varicocelectomy in subclinical group of patients unless no identifiable causes of semen abnormality.
Downloads
Baazeem A, Belzile E, Ciampi A, et al. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol. 2011; 60:796-808. DOI: https://doi.org/10.1016/j.eururo.2011.06.018
Kupis Ł, Dobro´nski PA, Radziszewski P. Varicocele as a source of male infertility - current treatment techniques. Central Eur J Urol. 2015; 68:365-370. DOI: https://doi.org/10.5173/ceju.2015.642
Razi M, Tavalaee M, Sarrafzadeh-Rezaei F, et al. Varicocele and oxidative stress: new perspectives from animal and human studies. Andrology. 2021; 9:546-558. DOI: https://doi.org/10.1111/andr.12940
Kohn TP, Kohn JR, Pastuszak AW. Varicocelectomy before assisted reproductive technology: are outcomes improved? Fertil Steril. 2017;108:385-391. DOI: https://doi.org/10.1016/j.fertnstert.2017.06.033
Peter C. Fretz, Jay I. Sandlow. Varicocele: current concepts in pathophysiology, diagnosis and treatment. Urol Clin N Am 2002;29:921- 937. DOI: https://doi.org/10.1016/S0094-0143(02)00075-7
Dubin L, Amelar RD. Varicocelectomy: 986 cases in a twelve-year study. Urology 1977;10:446-449. DOI: https://doi.org/10.1016/0090-4295(77)90132-7
Kim HJ, Seo JT, Kim KJ, et al. Clinical significance of subclinical varicocelectomy in male infertility: systematic review and metaanalysis. Andrologia. 2016; 48:654-661. DOI: https://doi.org/10.1111/and.12495
Merla A, Ledda A, Di Donato L, et al. Use of infrared functional imaging to detect impaired thermoregulatory control in men with asymptomatic varicocele. Fertil Steril. 2002; 78:199-200. DOI: https://doi.org/10.1016/S0015-0282(02)03155-2
Hauser R, Paz G, Botchan A, et al. Varicocele: effect on sperm functions. Hum Reprod Update. 2001; 7:482-485. DOI: https://doi.org/10.1093/humupd/7.5.482
Blumer CG, Fariello RM, Restelli AE, et al. Sperm nuclear DNA fragmentation and mitochondrial activity in men with varicocele. Fertil Steril. 2008; 90:1716-1722. DOI: https://doi.org/10.1016/j.fertnstert.2007.09.007
Sakamoto Y, Ishikawa T, Kondo Y, et al. The assessment of oxidative stress in infertile patients with varicocele. BJU Int. 2008;101:1547-1552. DOI: https://doi.org/10.1111/j.1464-410X.2008.07517.x
Khera M, Lipshultz LI. Evolving approach to the varicocele. Urol Clin North Am. 2008;35:183-9. DOI: https://doi.org/10.1016/j.ucl.2008.02.001
Will MA, Swain J, Fode M, et al. The great debate: varicocele treatment and impact on fertility. Fertil Steril. 2011; 95:841-852. DOI: https://doi.org/10.1016/j.fertnstert.2011.01.002
Zini A, Buckspan M, Berardinucci D, Jarvi K. Loss of left testicular volume in men with clinical left varicocele: correlation with grade of varicocele. Arch Androl. 1998; 41:37-41. DOI: https://doi.org/10.3109/01485019808988544
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
Kroese AC, de Lange NM, Collins J, Evers JL. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev. 2012;10:CD000479. DOI: https://doi.org/10.1002/14651858.CD000479.pub5
Meacham RB, Townsend RR, Rademacher D, Drose JA. The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography. J Urol. 1994. DOI: https://doi.org/10.1016/S0022-5347(17)35295-3
Okeke L, Ikuerowo O, Chiekwe I, et al. Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density? Int J Urol. 2007; 14:729-32. DOI: https://doi.org/10.1111/j.1442-2042.2007.01786.x
Blumer CG, Restelli AE, Giudice PT, et al. Effect of varicocele on sperm function and semen oxidative stress. BJU Int 2012; 109:259-65. DOI: https://doi.org/10.1111/j.1464-410X.2011.10240.x
Maciejko A, Kim P, Jang T, et al. Isolated teratospermia: is varicocelectomy indicated? J Urol. 2005; 173:369. DOI: https://doi.org/10.1016/S0022-5347(18)35495-8
Tulloch WS. A consideration of sterility factors in the light of subsequent pregnancies II. Sub fertility in the male. (Tr. Edinburgh Obst. Soc. Session 104). Edinb Med J. 1951; 59:29-34.
Scott LS. Varicocele: A treatable cause of subfertility. Br Med J. 1961; 1:788-90. DOI: https://doi.org/10.1136/bmj.1.5228.788
Dubin L, Amelar RD. Etiologic factors in 1294 consecutive cases of male infertility. Fertil Steril. 1971; 22:469-474. DOI: https://doi.org/10.1016/S0015-0282(16)38400-X
Silber SJ. The varicocele dilemma. Hum Reprod Update. 2001;7:70-77. DOI: https://doi.org/10.1093/humupd/7.1.70
Redmon JB, Carey P, Pryor JL. Varicocele-the most common cause of male factor infertility. Hum Reprod Update. 2002; 8:53-58. DOI: https://doi.org/10.1093/humupd/8.1.53
Pauroso S, Di Leo N, Fulle I, et al. Varicocele: Ultrasonographic assessment in daily clinical practice. J Ultrasound. 2011; 14:199-204. DOI: https://doi.org/10.1016/j.jus.2011.08.001
Muthukumar A, Sekar H, Krishnamoorthy S, Kumaresan N. Subclinical varicocele (SCV): what the urologists need to know? World J Surg Surgical Res. 2021;4:1281.
Schauer I, Madersbacher S, Jost R, et al. The impact of varicocelectomy on sperm parameters: a meta-analysis. J Urol. 2012;187:1540-1547. DOI: https://doi.org/10.1016/j.juro.2011.12.084
Birowo P, Tendi W, Widyahening IS, et al. The benefits of varicocele repair for achieving pregnancy in male infertility: a systematic review and meta-analysis. Heliyon. 2020; 6:e05439. DOI: https://doi.org/10.1016/j.heliyon.2020.e05439
Bsat FA. & Masabni R. Effectiveness of varicocelectomy in varicoceles diagnosed by physical examination versus doppler studies. Fertil Steril. 1988; 50:321-323. DOI: https://doi.org/10.1016/S0015-0282(16)60080-8
Pierik FH, Vreeburg JT, Stijnen T, et al. Improvement of sperm count and motility after ligation of varicoceles detected with colour Doppler ultrasonography. Int J Androl. 1998; 21:256-260. DOI: https://doi.org/10.1046/j.1365-2605.1998.00123.x
Unal D, Yeni E, Verit A, Karatas OF. Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: a prospective randomized study. Int J Urol. 2001; 8:227-230. DOI: https://doi.org/10.1046/j.1442-2042.2001.00289.x
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.