Öz
Aim: We
aimed to investigate the effects of varicocelectomy on semen analysis and
pregnancy in infertile men.
Patients and Methods: We retrospectively reviewed the medical records of patients
underwent varicoselectomy between 2009 and 2014 in two referal hospitals, and
180 infertile patients with complete records were included. All surgeries were performed by using a
microscope or loop. The preoperative and postoperative sperm parameters and
spontaneous pregnancy rates were evaluated.
Results:
Mean age of the patients was 29.6 (17-46) years. 99 (55%) of the patients
achieved spontaneous pregnancy after the surgery. 81 (45%) of the patients were
guided to infertility polyclinics for assisted reproductive methods. When the
sperm parameters were analyzed, the rate of the patients who had improved sperm
concentrations were 22.7%; the rate of the patients who had improved sperm
motility (a+b) was 59.4%; the rate of
the patients who had improved sperm morphology was 51.1 (p<0.05).
Conclusion:
Consisted to the existing literature, our study has demonstrated the positive
effects of microscopic varicocelectomy on semen analysis and pregnancy rates.
Anahtar Kelimeler
Kaynakça
- 1. Nagler HM. Male factorinfertility: A solitary semen analysis can never predict normal fertility. Nat Rev Urol. 2011;8:16-7.
- 2. Harrison RM, Lewis RW, Roberts JA. Pathophysiology of varicocele in nonhuman primates: long-term seminal and testicular changes. Fertil Steril. 1986;46:500-10.
- 3. Vanlangenhove P, Dhondt E, Everaert K, Defreyne L. Pathophysiology, diagnosis and treatment of varicoceles: a review. Minerva Urol Nefrol. 2014;66:257-82.
- 4. 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;19:532-8.
- 5. Ficarra V, Crestani A, Novara G, Mirone V. Varicocele repair for infertility: what is the evidence? Curr Opin Urol. 2012;22:489-94.
- 6. Velasquez M, Tanrikut C. Surgical management of male infertility: an update. Transl Androl Urol. 2014;3:64-76.
- 7. 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;148:1808-11.
- 8. Pan LJ, Xia XY, Huang YF, Gao JP. [Microsurgical varicocelectomy for male infertility]. Zhonghua Nan Ke Xue. 2008;14:640-4.
- 9. Al-Said S, Al-Naimi A, Al-Ansari A, Younis N, Shamsodini A, A-sadiq K et al. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008;180:266-70.
- 10. Ding H, Tian J, Du W, Zhang L, Wang H, Wang Z. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int. 2012;110:1536-42.
- 11. Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007;69:417-20.
- 12. Walsh TJ, Wu AK, Croughan MS, Turek PJ. Differences in the clinical characteristics of primarily and secondarily infertile men with varicocele. Fertil Steril. 2009;9:826-30.
- 13. Nagy ZP, Liu J, Joris H. et al. The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters. Hum Reprod. 1995;10:1123-9.
- 14. Leung L, Ho KL, Tam PC, Yiu MK. Subinguinal microsurgical varicocelectomy for male factor subfertility: ten-year experience. Hong Kong Med J. 2013;19:334-40.
- 15. McIntyre M, Hsieh TC, Lipshultz L.Varicocele repair in the era of modern assisted reproductive techniques. Curr Opin Urol. 2012;22:517-20.
- 16. Pasqualotto FF, Braga DP, Figueira RC, Setti AS, Iaconelli A Jr, Borges E Jr. Varicocelectomy does not impact pregnancy outcomes following intracytoplasmic sperm injection procedures. J Androl. 2012;33:239-43.
- 17. Yuan R, Zhuo H, Cao D, Wei Q. Efficacy and safety of varicocelectomies: A meta-analysis. Syst Biol Reprod Med. 2017;63: 120-9.
- 18. Peng J, Zhang Z, Cui W, Yuan Y, Song W, Gao B et al. Spontaneous pregnancy rates in Chinese men under going microsurgical subinguinal varicocelectomy and possible preoperative factors affecting the outcomes. Fertil Steril. 2015;103:635-9.
- 19. García Navas R, Maganto Pavón E, García-Ortells D. et al. [Infertility and varicocele through history]. Arch Esp Urol. 2004;57:876-82.
- 20. Kumar R, Gupta NP. Subinguinal microsurgical varicocelectomy: evaluation of the results. See comment in PubMed Commons belowUrol Int. 2003;71:368-72.
- 21. 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;55:750-4.
- 22. Aşci R, Sarikaya S, Büyükalpelli R, Yilmaz AF, Yildiz S. The outcome of varicocelectomy in subfertile men with an absent or atrophic right testis. Br J Urol. 1998;81:750-2.
- 23. Seo JT, Kim KT, Moon MH, Kim WT. The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele. Fertil Steril. 2010;93:1907-10.
- 24. Flati G, Porowska B, Flati D, Veltri S, Sportelli G, Carboni M. Improvement in the fertility rate after placement of microsurgical shunts in men with recurrent varicocele. Fertil Steril. 2004;82:1527-31.
Öz
Amaç: Primer
infertil erkeklerde mikroskobik varikoselektomi ameliyatının semen analizi ve
gebelik üzerine etkilerini değerlendirmeyi amaçladık.
Hastalar ve Yöntem: İki merkezde 2009-2014 yılları arasında, tek taraflı ya da bilateral
mikroskobik varikoselektomi yapılan hastaların verileri retrospektif olarak
incelendi ve kayıtları tam olan 180 primer infertil hasta çalışmaya dahil
edildi. Tüm hastalarda büyüteç olarak mikroskop ya da loop kullanılarak işlem
gerçekleştirildi. Hastaların preoperatif ve postoperatif sperm parametreleri ve
spontan gebelik oranları karşılaştırıldı.
Bulgular:
Hastaların yaş ortalaması 29.6 (17-46) yıl idi. 99 (%55) hastada cerrahi
sonrası spontan gebelik sağlanırken, 81 (%45) hasta yardımcı üreme yöntemleri
için infertilite polikliniğine yönlendirildi. Sperm parametreleri
irdelendiğinde, konsantrasyonunda düzelme saptanan hasta oranı %22.7;
hareketlilikte (a+b) düzelme saptanan hasta oranı %59.4; morfolojide düzelme
saptanan hasta oranı oranı ise %51.1 olarak tespit edildi (p<0.05).
Sonuç: Bu
çalışma, literatür verileriyle uyumlu olarak primer infertil hastalarda
mikroskopik varikoselektominin semen analizi ve gebelik üzerine olan olumlu
katkısını ortaya koymuştur.
Anahtar Kelimeler
Kaynakça
- 1. Nagler HM. Male factorinfertility: A solitary semen analysis can never predict normal fertility. Nat Rev Urol. 2011;8:16-7.
- 2. Harrison RM, Lewis RW, Roberts JA. Pathophysiology of varicocele in nonhuman primates: long-term seminal and testicular changes. Fertil Steril. 1986;46:500-10.
- 3. Vanlangenhove P, Dhondt E, Everaert K, Defreyne L. Pathophysiology, diagnosis and treatment of varicoceles: a review. Minerva Urol Nefrol. 2014;66:257-82.
- 4. 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;19:532-8.
- 5. Ficarra V, Crestani A, Novara G, Mirone V. Varicocele repair for infertility: what is the evidence? Curr Opin Urol. 2012;22:489-94.
- 6. Velasquez M, Tanrikut C. Surgical management of male infertility: an update. Transl Androl Urol. 2014;3:64-76.
- 7. 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;148:1808-11.
- 8. Pan LJ, Xia XY, Huang YF, Gao JP. [Microsurgical varicocelectomy for male infertility]. Zhonghua Nan Ke Xue. 2008;14:640-4.
- 9. Al-Said S, Al-Naimi A, Al-Ansari A, Younis N, Shamsodini A, A-sadiq K et al. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008;180:266-70.
- 10. Ding H, Tian J, Du W, Zhang L, Wang H, Wang Z. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int. 2012;110:1536-42.
- 11. Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007;69:417-20.
- 12. Walsh TJ, Wu AK, Croughan MS, Turek PJ. Differences in the clinical characteristics of primarily and secondarily infertile men with varicocele. Fertil Steril. 2009;9:826-30.
- 13. Nagy ZP, Liu J, Joris H. et al. The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters. Hum Reprod. 1995;10:1123-9.
- 14. Leung L, Ho KL, Tam PC, Yiu MK. Subinguinal microsurgical varicocelectomy for male factor subfertility: ten-year experience. Hong Kong Med J. 2013;19:334-40.
- 15. McIntyre M, Hsieh TC, Lipshultz L.Varicocele repair in the era of modern assisted reproductive techniques. Curr Opin Urol. 2012;22:517-20.
- 16. Pasqualotto FF, Braga DP, Figueira RC, Setti AS, Iaconelli A Jr, Borges E Jr. Varicocelectomy does not impact pregnancy outcomes following intracytoplasmic sperm injection procedures. J Androl. 2012;33:239-43.
- 17. Yuan R, Zhuo H, Cao D, Wei Q. Efficacy and safety of varicocelectomies: A meta-analysis. Syst Biol Reprod Med. 2017;63: 120-9.
- 18. Peng J, Zhang Z, Cui W, Yuan Y, Song W, Gao B et al. Spontaneous pregnancy rates in Chinese men under going microsurgical subinguinal varicocelectomy and possible preoperative factors affecting the outcomes. Fertil Steril. 2015;103:635-9.
- 19. García Navas R, Maganto Pavón E, García-Ortells D. et al. [Infertility and varicocele through history]. Arch Esp Urol. 2004;57:876-82.
- 20. Kumar R, Gupta NP. Subinguinal microsurgical varicocelectomy: evaluation of the results. See comment in PubMed Commons belowUrol Int. 2003;71:368-72.
- 21. 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;55:750-4.
- 22. Aşci R, Sarikaya S, Büyükalpelli R, Yilmaz AF, Yildiz S. The outcome of varicocelectomy in subfertile men with an absent or atrophic right testis. Br J Urol. 1998;81:750-2.
- 23. Seo JT, Kim KT, Moon MH, Kim WT. The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele. Fertil Steril. 2010;93:1907-10.
- 24. Flati G, Porowska B, Flati D, Veltri S, Sportelli G, Carboni M. Improvement in the fertility rate after placement of microsurgical shunts in men with recurrent varicocele. Fertil Steril. 2004;82:1527-31.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Mart 2018 |
| Gönderilme Tarihi | 13 Ocak 2018 |
| Kabul Tarihi | 29 Ocak 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 2 Sayı: 1 |
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