Melatonin therapy adds extra benefit to varicecelectomy in terms of sperm parameters, hormonal profile and total antioxidant capacity: A placebo-controlled, double-blind trial.

In this study, we aimed at investigating the impact of melatonin supplementation on semen parameters, hormonal profile and total antioxidant capacity after varicocelectomy. Infertile male patients who were diagnosed with varicocele and underwent subinguinal varicocelectomy were included in the study. After performing subinguinal varicocelectomy, the patients were randomised into two groups: 27 receiving melatonin for 3 months and 27 as the placebo-controlled group receiving placebo for 3 months. The pre-operative parameters of semen analyses, hormonal profile and seminal oxidative stress status of both groups were compared with those of post-operative parameters. There were statistically significant improvements in post-operative parameters of semen analyses (sperm concentration, motility and proportions of normally formed spermatozoa), peripheral blood inhibin B and total antioxidant capacity in melatonin group compared with placebo group. In conclusion, melatonin therapy adds extra benefit to varicecelectomy in terms of sperm parameters, peripheral blood inhibin B and total antioxidant capacity; however, further studies including large number of samples are needed to make a proper decision on melatonin supplementation after varicocelectomy.

A rational approach to the management of varicocele-associated nonobstructive azoospermia.

A consensus needs to be reached on a rational approach to infertile men with varicocele-associated nonobstructive azoospermia. Future studies are warranted to understand the mechanism behind the variable influence of varicocele on testicular function, which causes partial or complete damage of spermatogenesis in some cases and leaves it unaltered in others.

Other work has highlighted the limitations of using histopathology to predict success after varicocelectomy.

The morbidity associated with performing testicular biopsy on all men before varicocele repair appears to outweigh the benefit of any prognostic information obtained.

Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study.

OBJECTIVE: To compare semen parameters, pregnancy, recurrence, and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men. DESIGN: Prospective, randomized study. SETTING: Ghodran General Hospital, Kingdom of Saudi Arabia. PATIENT(S): One hundred sixty-two infertile male patients with varicocele. INTERVENTION(S): Eighty-two patients were treated by microsurgical subinguinal varicocelectomy (MSSIV) (group I), whereas 80 patients were treated by conventional, nonmagnified subinguinal varicocelectomy (NMSIV) (group II). MAIN OUTCOME MEASURE(S): The patients were postoperatively evaluated by physical examination and semen analysis after 4 and 12 months. Pregnancy rate was monitored during the follow-up period. RESULT(S): Postoperatively, mean sperm count and motility improved significantly in both groups: 42.7% and 67.1% of the MSSIV group and 23.7% and 33.8% of the NMSIV group showed ≥50% improvement in sperm count and motility after 1 year. Patients having bilateral varicocele showed significantly better improvement of sperm count than those with unilateral varicocele after both MSSIV and NMSIV. The pregnancy rate at the end of the follow-up period reached 37.8% in the MSSIV group and 21.2% in the NMSIV group. The recurrence rate was zero in the MSSIV group and 11.3% in the NMSIV group. The rate of hydrocele formation was 1.2% in the MSSIV group and 8.7% in the NMSIV group. CONCLUSION(S): Microsurgical subinguinal varicocelectomy has a better improving effect on sperm count and motility, higher spontaneous pregnancy rates, and lower postoperative recurrence and hydrocele formation than conventional subinguinal varicocelectomy in infertile men.

The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele.

OBJECTIVE: To assess the improvement of seminal characteristics and pregnancy rates after microsurgical varicocelectomy in men with subclinical varicocele. DESIGN: Retrospective study. SETTING: University infertility clinic. PATIENT(S): One hundred forty-three patients with a subclinical left-sided varicocele. INTERVENTION(S): Patients who agreed to microsurgical varicocelectomy (n = 25, surgery group), medical treatment with L-carnitine (n = 93 drug group), and those who did not agree to any treatment (n = 25, observation group) were enrolled. MAIN OUTCOME MEASURE(S): Semen characteristics were reevaluated twice 6 months after treatment. The natural pregnancy rates were estimated by telephone interview between 1 and 2 years after treatment. RESULT(S): In the surgery group, sperm counts improved significantly after microsurgical varicocelectomy. In the drug group, however, sperm parameters did not significantly improve after treatment. Natural pregnancy rates were 60.0% in the surgery group, 34.5% in the drug group, and 18.7% in the observation group. The natural pregnancy rate of the surgery group was higher than the other groups, and there were statistically significant differences among the three groups. CONCLUSION(S): Surgical treatment is the best option for management of subclinical varicocele.

The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply.

OBJECTIVE: To evaluate the impact of systematic use of intraoperative Doppler ultrasound during microsurgical subinguinal varicocele repair. DESIGN: Prospective clinical study. SETTING: Andrology laboratory and male infertility section of the urology department of a tertiary care hospital. PATIENT(S): Two hundred and thirteen men with clinical varicocele. INTERVENTION(S): Subinguinal microsurgical varicocele ligation using an intraoperative vascular Doppler flow detector. MAIN OUTCOME MEASURE(S): Number of veins ligated, lymphatic spared, arteries identified or accidentally ligated. RESULT(S): A statistically significant greater number of arteries were identified and preserved when intraoperative vascular Doppler was used. In addition, the average number of internal spermatic veins ligated was statistically significantly greater in the same group. Accidental artery ligation occurred in two cases (1.1%) in which the Doppler was not applied. There was no statistically significant difference in number of lymphatics spared between groups. CONCLUSION(S): Our findings showed that concomitant use of intraoperative vascular Doppler during microsurgical varicocelectomy allows more arterial branches to be preserved, and more internal spermatic veins are likely to be ligated. This device should be considered an attractive tool to improve surgical outcomes and safety.

Varicocele: Una entidad frecuente

El varicocele, cuadro clínico frecuentemente visto, es la causa corregible más común de infertilidad;sin embargo, a pesar de múltiples estudios aún existen muchas preguntas sin respuesta y mucho de hipóteticoen los conceptos respecto a la entidad. En el presemte artículo se revisan los diferentes criterios existentes sobre el varicocele: las posibles hipótesis etiológicas, la clínica, las ayudas diagnósticas, el tratamiento principalmente quirúrgico, y por último, se plantean las posibles teorías que causan su estrecha relación con la infertilidad. Se pretende que al aumentar el conocimiento sobre el varicocele se le otorgue mayor importancia y se logre prevenir sus complicaciones y secuelas, principalmente la infertilidad