Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele.

OBJECTIVES: To prospectively compare sperm parameters, pregnancy and recurrence rates, and complications after randomized high ligation surgery versus microsurgical high inguinal varicocelectomy (MHIV). METHODS: Varicocele was diagnosed by physical examination and color Doppler ultrasound in 468 patients who underwent one of two procedures: high ligation surgery (n = 232) or MHIV (n = 236). The high ligation surgery was left unilateral in 142 and bilateral in 90. The MHIV was left unilateral in 128 and bilateral in 108. The patients were postoperatively evaluated by spermiograms and physical examination. The pregnancy rate was monitored for 2 years. RESULTS: One year after surgery, 34.05% in the high ligation group and 46.61% in the MHIV group had a more than 50% increase in their total motile sperm count (P = 0.000). The increase in sperm count was not statistically different between the two groups (P = 0.1), but the difference in the increase in sperm motility in the MHIV group was statistically significant (P = 0.000). Pregnancy rates at the end of 2 years reached 33.57% in the high ligation group and 42.85% in the MHIV group, not a statistically significant difference (P = 0.0571). The postoperative recurrence as detected by physical examination was markedly different between the two techniques. The recurrence rate was 15.51% in the high ligation group and 2.11% in the MHIV group (P = 0.000). Also, the incidence of postoperative hydrocele was significantly different between the two groups (9.09% in the high ligation group and 0.69% in the MHIV group; P = 0.000). CONCLUSIONS: MHIV has lower recurrence and hydrocele rates, a higher increase in sperm motility, and results in higher pregnancy rates. Therefore, it should be the preferred technique for varicocelectomy.

Color Doppler ultrasound assessment of penile vascular system in men with Peyronie's disease.

The purpose of this study was to evaluate the penile vascular function by color Doppler ultrasonography (CDU) in patients with Peyronie's disease. A total of 136 men with Peyronie's disease were stratified according to their potency by history as Group I consisting of potent patients and Group II consisting of patients with erectile dysfunction. They were all evaluated by penile CDU. Overall, 70.6% had erectile dysfunction by history. CDU revealed penile vascular abnormalities in 76.5%. In Group I, veno-occlusive dysfunction (VOD) was observed in 40% while mixed (arterial + venous) vascular disease was diagnosed in 10%. Penile vascular disease was detected in 87.5% patients in Group II (ie VOD in 28%, arterial disease in 9.3% and mixed vascular disease in 50%). The prevalence of arterial disease on CDU among Peyronie' patients with erectile dysfunction (59.3%) was significantly (P < 0.05) higher then it was among potent patients (10%). The prevalence of pure VOD was almost similar for patients with or without erectile dysfunction (P < 0.05). We conclude that penile vascular abnormalities can be observed in 76.5% on cases with Peyronie's disease by CDU and this ratio significantly increases to 87.5% among cases with erectile dysfunction by history. Our data also indicate that arterial disease, accounts for much of the diminished rigidity in men with Peyronie's disease.

Does response to treatment of ejaculatory duct obstruction in infertile men vary with pathology?

OBJECTIVE: To describe the pathology-specific response to transurethral resection of ejaculatory ducts (TURED) in patients with complete or partial ejaculatory duct obstruction and to evaluate the role of TURED in light of powerful assisted reproductive technologies. DESIGN: Retrospective clinical study. SETTING: University hospital. PATIENT(S): Thirty-eight infertile men with obstruction of the ejaculatory ducts. INTERVENTION(S): Diagnosis by transrectal ultrasonography or magnetic resonance imaging, and treatment with TURED. MAIN OUTCOME MEASURE(S): Changes in semen variables, pregnancy outcomes, and complication rates were analyzed before and after surgery. RESULT(S): Improvement in semen variables was significantly better in patients with partial obstruction (94%) of ducts than in those with complete obstruction (59%) (P=.04). Cystic obstruction, especially midline and eccentric cysts, responded best to TURED. Before surgery, all patients were candidates for IVF/ICSI; after surgery, 32% of azoospermic men and 81% of oligospermic men conceived spontaneously or were referred for IUI instead of IVF/ICSI. CONCLUSION(S): Ejaculatory duct obstruction due to cysts appears to respond best to TURED. In addition, TURED may decrease the need for IVF/ICSI as primary treatment in many cases. Finally, TURED may allow IVF/ICSI to be performed with ejaculated rather than surgically retrieved sperm.

Birth after intracytoplasmic sperm injection with use of testicular sperm from men with Kartagener/immotile cilia syndrome.

OBJECTIVE: To describe two cases of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) with testicular sperm in men with immotile cilia syndromes. DESIGN: Case report. SETTING: A university-based male infertility clinic and assisted reproduction unit. PATIENT(S): Two couples with male factor infertility due to Kartagener/immotile cilia syndrome. INTERVENTION(S): IVF/ICSI with testicular sperm. MAIN OUTCOME MEASURE(S): Semen characteristics, sperm viability, fertilization rate, and pregnancy. RESULT(S): With testicular sperm, the two pronuclear fertilization rates were 63% and 60% in two cases. One case resulted in the birth of normal healthy girl. CONCLUSION(S): With testicular sperm, successful oocyte fertilization after ICSI in couples with male Kartagener/immotile cilia syndrome is possible despite the lack of sperm motility.

Touch imprint cytology in biopsy of the infertile testis.

OBJECTIVE: To identify different cell types in the testis by using touch imprint cytology and to compare the cytologic findings to the histopathologic diagnosis in infertile men. STUDY DESIGN: This prospective study used touch imprint preparations and included 20 infertile men. The biopsy material obtained was stained with toluidine blue, May-Grünwald-Giemsa stain and Papanicolaou stain. The cytologic results for oligospermic, normospermic and azospermic men were compared to the specific histopathologic diagnosis. The proportion of spermatogenic versus Sertoli cells was calculated. The scores were compared between three groups based on the results of the histologic biopsy: normal spermatogenesis, hypospermatogenesis and incomplete spermatogenic arrest. RESULTS: The mean ratio of the spermatogenic cells versus Sertoli cells was statistically significantly different in the three groups (P < .01). The mean ratio of spermatogenic cells to Sertoli cells was higher in cases with normal spermatogenesis than in cases with hypospermatogenesis and incomplete spermatogenic arrest, revealing a statistical difference (P<.01). This ratio was not statistically significantly different between the hypospermatogenesis and incomplete spermatogenic arrest groups. CONCLUSION: A cytologic demonstration of germinal cells by using touch imprint preparations may be a guide for histologic diagnosis.

Treatment of penile incarceration in an impotent patient.

We report a case of penile incarceration in a 53-year-old impotent man. The base of the penis was encircled by a metal ring in order to achieve better erection. There was marked oedema of the entire penis distal to the constricting ring. The metal ring was removed successfully by cutting it with a steel saw.

A case of ureteral triplication (type 1) associated with vesicoureteral reflux in a solitary kidney.

Ureteral triplication is a rare congenital anomaly of the upper urinary tract. It is reported to be associated with an increased incidence of congenital anomalies as well as a predisposition to infection and calculus formation. We report a case of type 1 variant of ureteral triplication associated with vesicoureteral reflux into lower and mid pole ureters in a solitary kidney. To our knowledge ureteral triplication in a solitary kidney has not been described previously.

The assessment of constipation in monosymptomatic primary nocturnal enuresis.

OBJECTIVES: Nocturnal enuresis and constipation are common pediatric problems. The aim of this study was to assess the incidence of constipation in children with or without monosymptomatic primary nocturnal enuresis. METHODS: The study included 5350 children, ages 5-19 years, who were surveyed to detect the incidence of nocturnal enuresis. Of those surveyed, 679 (12.7%) had primary nocturnal enuresis. All children were questioned by mail with a standard form that addressed their micturition and defecation habits. The children those who had primary nocturnal enuresis were invited to the Pediatric Urology Section of the University Hospital. Of those 679 children, 125 kept that invitation. All 125 of those children underwent an abdominal ultrasound. Also, these children had serum creatinine levels drawn and plain abdominal films taken. RESULTS: Constipation, defined as less than 3 bowel movements per week, was seen in 48 of 679 children with nocturnal enuresis (7.06%). Of those 4671 children without nocturnal enuresis, only 68 (1.45%) had constipation. The difference in constipation between the two groups was statistically significant (z = -9.251; p = 0.000). Of note, 10 of the 125 children (8%), evaluated at the hospital, had constipation. None of the children had an abnormal neurologic examination. Finally, faecal loading was detected on the plain films of 8 of the 125 children evaluated, 7 of who had constipation. The sensitivity of grading plain films for faecal loading to denote constipation in this population was 87.5%. CONCLUSIONS: Children with primary nocturnal enuresis should be thoroughly assessed for coexisting constipation.

Prevalence of male pelvic dysfunction: results from the Turkish society of andrology male sexual health study group.

The objective of this study was to determine the prevalence of male pelvic dysfunction (MPD) and its correlation in men ≥40 years of age in a population-based study. This study was designed as a non-interventional, observational, cross-sectional field survey. Participating males of ≥40 years were randomly selected from 19 provinces of Turkey. All participants were asked to complete a survey including data regarding demographics, socio-economic status, socio-cultural factors, medical and sexual history, current medications, comorbidities and three validated questionnaires assessing lower urinary tract symptoms (International Prostate Symptom Score), erectile dysfunction (International Index of Erectile Function) and ejaculatory behaviour (Male Sexual Health Questionnaire-4). MPD was defined by combining abnormal scores calculated from all three questionnaires. All data were analysed statistically and p < 0.05 was accepted as significant. A total of 2730 males of ≥40 years (mean, 54.2 ± 10.6 years) were enrolled in this study. The prevalence of MPD was calculated as 24.4% among all participants. The prevalence of MPD was lowest at age between 40 and 49 years (9.1%) and highest at ≥70 years (76.6%), exhibiting correlation with age. Each decade of increase in age was associated with a 3.4-fold increase in presence of MPD. At logistic regression analyses; age, diabetes, hypertension, dyslipidemia, cardiovascular disease, obesity and lower income were found to be independent predictors for increased prevalence of MPD. This study reports prevalence of MPD as 24.4% in males of ≥40 years. Furthermore, age was found to be the main independent predictor of having MPD.

Efficacy and tolerability of udenafil in Turkish men with erectile dysfunction of psychogenic and organic aetiology: a randomized, double-blind, placebo-controlled study.

Udenafil is a potent phosphodiesterase type-5 inhibitor (PDE5) previously shown in studies conducted in populations of Eastern-Asian ethnicity, to significantly improve sexual function, in addition to a favourable safety profile. The purpose of this study was to evaluate the efficacy and safety of udenafil for the treatment of erectile dysfunction (ED), for the first time in a non-Eastern-Asian population. In this multicentre, randomized, double-blind, parallel, placebo-controlled study conducted in five centres in Turkey, 118 eligible subjects were randomized to receive udenafil 100 mg taken as on-demand or matching placebo for an 8-week treatment period. The primary efficacy variable was the change from baseline of the International Index of Erectile Function Questionnaire-Erectile Function Domain (IIEF-EFD) score, secondary efficacy variables were changes from baseline in IIEF Questionnaire Domains' 2-5 scores (Intercourse Satisfaction, Orgasmic Function, Sexual Desire, Overall Sexual Satisfaction) and IIEF Questionnaire Grand Total score, changes from baseline in penetration success rates (SEP2) and intercourse completion rates (SEP3) and evaluation of responses to the global assessment question (GAQ). Patients treated with udenafil demonstrated significantly higher increase in the IIEF-EFD scores compared with placebo-treated subjects [4.0 (95% CI: 1.3-6.6; p = 0.003)]. Similarly, greater improvements were observed in the scores for SEP2 [0.65 (95% CI: 0.02-1.3, p = 0.043)], SEP3 [0.9 (95% CI: 0.3-1.5, p = 0.003)] and two other IIEF Questionnaire Domains (Domain 4: Sexual Desire, Domain 5: Overall Sexual Satisfaction). The proportion of positive responses to the GAQ was greater in the udenafil compared to the placebo group (72.2% vs. 49.1%, p = 0.014). The most frequent treatment-emergent adverse events were headache, flushing and rhinorrhea, all of mild or moderate severity. This is the first study to demonstrate in a non-Eastern-Asian population that udenafil 100 mg taken as on-demand can effectively improve erectile function and is well tolerated.

Effect of diabetes mellitus on female sexual function and risk factors.

The study was conducted to investigate the effect of diabetes mellitus upon female sexual function, and to detect possible risk factors that might predict sexual dysfunction. The study consisted of 127 married women: 21 women with type 1 diabetes, 50 women with type 2 diabetes and 56 healthy women as a control. Female sexual functions were evaluated with a questionnaire to assess sexual desire, arousal, lubrication, orgasm, satisfaction and pain. The prevalence of sexual dysfunction was 71% in the type 1 diabetic group, 42% in the type 2 diabetic group and 37% in the control subjects. The scores for sexual desire, arousal and lubrication were significantly lower in the type 1 diabetes group than in the control subjects (p < 0.05). The scores of orgasm, satisfaction, dyspareunia and total sexual function were slightly lower in the type 1 diabetic group than in the other groups. No factor predicted sexual dysfunction in the diabetic women while further age, poor education, absence of occupation and menopause predicted sexual dysfunction in the control subjects. The prevalence of sexual dysfunction was significantly higher in the type 1 diabetic women than in the type 2 diabetics and control subjects. However, no risk factors that might cause sexual dysfunction could be predicted in diabetic women.

Does the positive intracavernous papaverine test always indicate a normal penile vascular system?

OBJECTIVE: A positive intracavernous papaverine test has been presumed to determine normal erectile hemodynamics. Recently, positive erectile responses to intracorporeal injection tests were reported in patients with penile arterial insufficiency. METHODS: This hypothesis was assessed by obtaining hemodynamic data using color Doppler ultrasonography in 417 patients with erectile dysfunction aged between 20 and 73 years (mean 43.06 +/- 13.66). A normal penile vascular system was found in 95 patients (22.79%), veno-occlusive dysfunction in 76 (18.22%), arteriogenic erectile dysfunction (ED) in 113 (27.10%) and mixed-type ED in 133 (31.89%). RESULTS: A positive erection response was achieved in 176 patients with combined intracavernosal injection of 60 mg papaverine and self-manual genital stimulation (CIS) test, while a negative response was observed in the remaining 241 (57.79%). Color Doppler ultrasonography combined with pharmacological erection has proved a normal penile vascular system in 94 (53.41%) and penile arterial insufficiency in 82 (46.59%) patients of those who gave a positive response to the CIS test. Also, a positive CIS test response was observed in all patients with unilateral arterial insufficiency (n = 31) and in 51 patients (62.19%) out of 82 with bilateral arterial insufficiency. CONCLUSION: A positive intracavernous papaverine test indicates veno-occlusive dysfunction competence but does not necessarily signify a normal penile arterial system. The CIS test should be combined with color Doppler ultrasonography in order to determine the vascular component of ED, since the differentiation is not possible between slight penile arterial insufficiency and psychogenic or neurogenic impotence with the CIS test.

Is routine hormonal measurement necessary in initial evaluation of men with erectile dysfunction?

To prospectively compare serum hormone levels and the incidence of hormonal pathologies between men with and without erectile dysfunction, and investigate risk factors that might predict hormonal pathologies in men complaining of erectile dysfunction. The study included 262 men with erectile dysfunction and 53 healthy men with no erectile dysfunction as a control group. All men enrolled in the study were evaluated with a detailed history, physical examination, international index of erectile function (IIEF-5), and serum hormone measurement. Hypotestosteronemia was considered as serum total testosterone value of < 3 ng/mL, and hyperprolactinemia was considered as serum prolactin level of > 18 ng/mL. Serum hormone levels and the incidence of hormonal abnormalities were compared between the two groups. In addition, risk factors for hormonal abnormalities were investigated. There were no significant differences in the mean serum FSH (p = 0.212), LH (p = 0.623), testosterone (p = 0.332) and prolactin values (p = 0.351) between the men with and without erectile dysfunction. Hypotestosteronemia was detected in 29 (11%) of the erectile dysfunction group and in 2 (3.7%) of the control group, revealing no significant difference (p = 0.104). Hyperprolactinemia was detected in 25 (9.5%) of the erectile dysfunction group and in 2 (3.7%) of the control group, revealing no significant difference (p = 0.171). To investigate risk factors that might predict hormonal pathologies, there were no significant differences in the patient age, duration of the sexual dysfunction, smoking history and duration, the presence of chronic disease and the type of erectile dysfunction. Our findings suggest that hormonal measurement should not be routinely performed in the initial evaluation of men presenting with erectile dysfunction, and may be necessary based only on the findings obtained with a careful history and physical examination.

Mast cells and fibrosis on testicular biopsies in male infertility.

Testicular dysfunction correlates with increased testicular mast cells. Mast cells can activate fibroblasts and promote collagen synthesis. The aim of the study was to examine testicular mast cells containing tryptase, and the relationship between mast cells and different fibrosis stages of interstitium and peritubular region of testes. Testicular biopsies obtained from 33 infertile men were assigned to 2 groups: normal spermatogenesis (n = 10) and defective spermatogenesis (n = 23). Total, interstitial, and peritubular mast cells were examined immunohistochemically using antihuman tryptase. The fibrosis stage was evaluated using vimentin and alpha-smooth muscle actin. The ratio of tubules with sclerosis to total tubules was also calculated. In all cases, mast cells were mainly localized in the interstitium. The number of total mast cells was significantly higher in defective spermatogenesis than in normal spermatogenesis (p = .048). In both groups, interstitial mast cells were higher than peritubular mast cells. However, the increase in peritubular region was much higher than the increase in interstitium. Total, peritubular, and interstitial mast cell counts were not different from each other, according to the changing fibrosis stages. Total and interstitial mast cells were significantly higher in the cases with sclerosing seminiferous tubules than in the cases with no sclerosis (p = .04 and p = .024, respectively). The mast cells and the mast cell product tryptase could be involved in the etiology of defective spermatogenesis, especially whenever the last stage (tubular hyalinization and sclerosis) takes place.

Posttraumatic high-flow priapism treated by N-butyl-cyanoacrylate embolization.

A patient with high-flow priapism was treated by transcatheter embolization of a posttraumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate (NBCA), resulting in complete detumescence. Erectile function has been preserved during a 3-month follow-up. Only two patients with NBCA embolization for high-flow priapism have been reported previously.

Interferon alpha-2b may impair testicular histology including spermatogenesis in a rat model.

Interferon-alpha has been used in various diseases at the reproductive ages. However, the effect of interferon-alpha on testicular histology has not been studied in literature. The aim of this study was to investigate the effects of interferon alpha-2B on testicular histology including spermatogenesis in a rat model. Seventeen adult male Wistar albino rats were divided into 3 groups: Six rats received 7.500 units (5 MIU/m2) of interferon alpha-2B (Intron), considered clinical treatment dose range. Six rats received 30.000 units (20 MIU/m2) of interferon alpha-2B (Intron), considered high treatment dose. Five rats served as a control group receiving 0.5 mL of saline injection. All injections were done intraperitoneally 3 times weekly for 3 weeks under inhalation anesthesia. All rats underwent bilateral orchiectomy 30 days after the experiment. Histological examination included the mean seminiferous tubular diameter (STD), germinal epithelial cell thickness (GECT), and testicular biopsy score (TBS). The mean STD was significantly lower in the low-dose interferon and high-dose interferon groups than in the control group (p = 0.008 and p = 0.004, respectively). The mean GECT was significantly lower in the low-dose interferon and high-dose interferon groups than in the control group (p = 0.008 and p = 0.004, respectively). The mean TBS was significantly lower in the low-dose interferon group (p = 0.05) and the high-dose interferon group (p = 0.01) than in the control group. The decreases in the mean values of the STD, GECT and TBS were not related to the interferon dose. Interferon alpha-2B may impair testicular histology even in clinical widely used treatment dose. Therefore, men at the reproductive ages should be fully informed for the use of interferon-alpha in the treatment of various diseases.

Is routine urinary tract investigation necessary for children with monosymptomatic primary nocturnal enuresis?

OBJECTIVES: To investigate in a prospective study the role of bladder function and to compare the results of urinary tract ultrasonography and urinalysis in children with and without primary nocturnal enuresis because, although this is a common problem in children, the etiology and mechanisms of the disorder have not been elucidated. METHODS: The study included 106 children with monosymptomatic primary nocturnal enuresis and a control group of 57 children with no history of voiding dysfunction, aged 5 to 19 years. All children underwent urinalysis, bladder and upper urinary tract ultrasonography, and uroflowmetry. The bladder capacity, bladder wall thickness, and postvoid residual volume were measured using ultrasonography. The findings were compared between the enuresis and control groups according to age: 5 to 9 years, 10 to 14 years, and 15 to 19 years. RESULTS: The mean age was 9.6 +/- 3.1 years in the nocturnal enuresis group and 9.4 +/- 3.3 years in the control group (P = 0.727). The mean number of defecations per week was significantly lower statistically in the enuresis group than in the control group in the age categories of 5 to 9 years and 10 to 14 years (P = 0.038 and P = 0.018, respectively), and the mean number of urinations per day was significantly higher statistically in the enuresis group than in the control group in the age groups of 5 to 9 years and 10 to 14 years (P = 0.002 and P = 0.001, respectively). The bladder capacity, bladder wall thickness, postvoid residual volume, uroflowmetry maximal flow rate, and average flow rate were not significantly different statistically between the children with primary nocturnal enuresis and the control group in the three age brackets. Urinary infection was detected in 2 children (1.88%) in the nocturnal enuresis group and none of the children in the control group (P = 0.547). Upper urinary tract abnormalities detected by ultrasonography were seen in 3 children (2.83%) in the nocturnal enuresis group and 1 child (1.75%) in the control group, revealing no statistical significance (P = 0.671). CONCLUSIONS: Our findings show that the ultrasonographic and uroflowmetry findings on bladder function and the upper urinary system and the incidence of urinary infection are similar in children with and without nocturnal enuresis. Obtaining a voiding and elimination diary in conjunction with a good history may be beneficial in children with monosymptomatic primary nocturnal enuresis. In addition, routine urinalysis may be unnecessary in the evaluation of children with monosymptomatic primary nocturnal enuresis after obtaining a careful and complete history of the voiding dysfunction.

Microsurgical inguinal varicocele repair in azoospermic men.

OBJECTIVES: To evaluate the efficacy of microsurgical inguinal varicocele repair in nonobstructive azoospermic men with palpable varicocele and to determine predictive parameters of outcome. METHODS: After standard diagnostic evaluation, 24 pellet (-) completely azoospermic men and 14 pellet (+) virtually azoospermic men underwent microsurgical inguinal varicocele repair. Testicular core biopsy was also performed perioperatively in all patients. The outcome was assessed in terms of improvement in semen parameters and spontaneous pregnancy. RESULTS: After a mean follow-up of 13.4 +/- 4.7 months, motile sperm in the ejaculate could be identified in 5 (21%) of the completely azoospermic patients, and these patients were rescued from invasive sperm extraction techniques when referred to intracytoplasmic sperm injection. Testicular histopathology of these patients with postoperative improvement revealed maturation arrest at spermatid stage (n = 3), Sertoli-cell-only (SCO) pattern with focal spermatogenesis (n = 1), and hypospermatogenesis (n = 1). None of the patients with pure SCO pattern or maturation arrest at spermatocyte stage had improvement after varicocele repair. However, improvement in semen parameters was observed in 12 (85.7%) patients with virtual azoospermia, 4 (28.6%) achieved a total motile sperm count greater than 5 million, and spontaneous pregnancy occurred with 3 (21.4%) of them. CONCLUSIONS: Microsurgical inguinal varicocele repair offers completely azoospermic men the chance to provide motile sperm via ejaculate in 21%. Moreover, 28.6% of virtually azoospermic men are rescued from ICSI procedures as an initial treatment modality. Results of varicocele repair in azoospermic men also reveal that a certain threshold of spermatogenesis, requiring the presence of at least spermatids, is necessary for effective varicocele repair.

Response to varicocelectomy in oligospermic men with and without defined genetic infertility.

OBJECTIVES: To compare the clinical characteristics of infertile men who have varicocele with and without a genetic anomaly, and report the results of varicocelectomy in these two cohorts of men. METHODS: Study subjects included 33 men who underwent genetic counseling and testing for a diagnosis of oligospermia with varicocele. Seven men were diagnosed with coexisting genetic infertility (genetic [+]; abnormal karyotype in 4, Y chromosome microdeletion in 3), and 26 men with varicocele and no genetic abnormality (genetic [-]). Five patients (Y chromosome microdeletions in 2, abnormal karyotype in 3) in the genetic (+) group and 14 patients in the genetic (-) group underwent microsurgical subinguinal varicocelectomy. Semen and hormonal parameters, physical examination findings, as well as the response to varicocele repair were compared between the two groups. Varicocele response was defined as a 50% increase in total motile sperm count in the ejaculate. RESULTS: Mean preoperative seminal and hormonal parameters were not statistically significantly different between the two groups. Significant differences were observed in the volume of the right and left testicles between the two groups (left: P = 0.007; right: P = 0.04). Although 7 of 13 evaluable patients (54%) in the genetic (-) group had a seminal response to varicocelectomy, none of 5 patients in the genetic (+) group showed improvement in semen quality. CONCLUSIONS: From this early experience, men with varicocele and genetic lesions appear to have a poorer response to varicocele repair than men without coexisting genetic lesions. These data may have implications for counseling male factor infertility patients contemplating varicocele treatment.