Original Papers - Andrology Open access

The changes of semen parameters of patients with clinical versus subclinical varicocele managed by laparoscopic varicocelectomy: observational study

Authors

Published
30 June 2025
Section
Original Papers - Andrology
DOI
10.4081/aiua.2025.13938

Abstract

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.

Keywords

References

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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.
  22. 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
  23. 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
  24. Silber SJ. The varicocele dilemma. Hum Reprod Update. 2001;7:70-77. DOI: https://doi.org/10.1093/humupd/7.1.70
  25. 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
  26. 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
  27. 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.
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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

Author Biography

  • Tamer A. Abouelgreed, Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo

    Department of Urology, Faculty of Medicine, Gulf Medical University, Ajman, United Arab Emirates

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2025 the Author(s)

Creative Commons License

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.