This descriptive survey was conducted on a sum of 844 patients who underwent Varicocele surgery at Prince Hussein urogenital medicine centre, for sterility between the period of June 2003 and June 2008, surgery was performed for patients upon showing to our clinic complaining of sterility for one twelvemonth or more in the absence of female factor for sterility. Patients were non-randomly selected. Sperm concentration, motility and morphology was assessed by analysis of at least two different seeds specimens each obtained after a 5 yearss period of sexual abstention and separated by three hebdomads interval. Post surgery patients were classified as respondents ( more than 50 % additions in sperm parametric quantities ) and non respondents. Simple statistical method ( frequence, mean and per centum ) was used to depict the survey variables.
Consequences: –
Surgical intervention of clinical tangible Varicocele successfully cured over 95 % of Varicocele. Post surgery spermatogenesis was improved in 256 patients ( 30.3 % ) ,
Sperm concentration increased to variable grades from 6.23 to 12.1 million among these patients with mean of 9.2 million, sperm motility improved from 5.2 % to 18.7 % with mean of 8.3 % . Spontaneous gestation was achieved in 194 ( 23 % ) couples within 12 months following surgery.
Decision: –
Varicocelectomy is safe, effectual and associated with a rapid recovery and minimum morbidity. Varicocelectomy resulted in the initiation or sweetening of spermatogenesis to several work forces with clinical Varicocele and unnatural seeds parametric quantities. Despite the absence of unequivocal surveies on the sterility result of Varicocele surgery, it is sensible to be considered as an option in selective patients with semen abnormalcies.
Keywords: – Sterility, Spermatogenesis, Varicocele.
Introduction: –
Varicocele, which is unnatural tortuousness and dilation of venas of pampiniform rete within the spermous cord, is the most normally seen and correctable cause of male factor sterility ( 1 ) , although it presents in 15 % of general male population, 40 % of work forces showing with sterility have Varicocele ( 2 ) . The ground for sterility associated with Varicocele are ill-defined, possibly the accretion of blood cause the testicles to be hotter and so damage sperm production ; or the pooled blood lips over with unnatural endocrines which may alter the manner the testicles make sperms ( 3 ) .
Merely Varicocele detected by physical scrutiny should be considered potentially important, and if the Varicocele coexists with impaired seeds quality, surgical fix may potentially reconstruct spermatogenesis and birthrate. ( 4 ) .
Varicoceles can be treated surgically ( unfastened and laparoscopic ) or radiologically. ( 5 ) .
Varicocele frequence found to be higher in first grade relations particularly among brothers. ( 6 ) .
This survey aims to find the result of surgical techniques for the intervention of testicular varicosity to better birthrate among sterile male at Prince Hussein Urology Center.
Methods: –
This descriptive survey was conducted on a sum of 844 patients who underwent Varicocele surgery at Prince Hussein urogenital medicine centre, for sterility between the period of June 2003 and June 2008, surgery was performed for patients upon showing to our clinic complaining of sterility for one twelvemonth or more in the absence of female factor for sterility. Patients were non-randomly selected. Post surgery patients were classified as respondents ( more than 50 % additions in sperm parametric quantities ) and non respondents. Patients were followed for one twelvemonth after surgery.
Varicocelectomy was performed utilizing inguinal attack ( inguen ) in 196 patients, retroperitoneal ( abdominal ) attack in 600 instances and laparoscopic varicocelectomy in 48 instances.
Isolated left side varicocelectomy were performed in 766 patients, right side in 4 instances and bilateral varicocelectomy in the staying 74 patients.
Patients age scope between 20 old ages up to 40 old ages with average age of 28 old ages.
Sperm concentration, motility and morphology were confirmed by analysis of at least two different seeds specimens each obtained after a 5 yearss period of sexual abstention and separated by three hebdomads interval harmonizing to World Health Organization guidelines categorization, before surgery and so three and six months after surgery. Azospermia was confirmed in the absence of sperms in all analysis, terrible oligospermia was defined as less than 5 1000000s /ml in all analysis submitted.
Post surgery patients were classified as respondent ( more than 50 % additions in sperm count ) and non respondent.
Serum follicular exciting endocrine, luteinizing endocrine, lactogenic hormone and testosterone degree were checked prior to surgery to except other endocrinal causes for sterility.
Out of 844 patients, 826 patients underwent the process on the footing of out patient & A ; acirc ; ˆ™s surgery and discharged same twenty-four hours of surgery, 4 patients were admitted one twenty-four hours before surgery due to underlying medical unwellnesss and discharged foremost twenty-four hours after surgery, 14 patients were admitted after surgery for one twenty-four hours due to trouble intolerability. Simple statistical method ( frequence, mean and per centum ) was used to depict the survey variables.
Consequences: –
We found that surgical intervention of clinical tangible Varicocele successfully cured in over 95 % of Varicocele in our patients. Post surgery spermatogenesis was induced in 256 ( 30.33 % ) ,
Sperm concentration increased to variable grades from 6.23 to 12.1 million in some patients with norm of 9.2 million, sperm motility improved from 5.2 % to 18.7 % with norm of 8.3 % .
Fourteen patients were admitted station surgery because of hurting intolerability and high dosage of analgesia were given and patients were admitted for observation and dismissed 2nd twenty-four hours. Three instances with simple wound infection treated by day-to-day dressing and healed wholly, 8 patients ( 1 % ) presented with hydrocele after surgery, 40 patients ( 5 % ) presented with return of varicocele. Spontaneous gestation was achieved in 194 ( 23 % ) couples within 12 months following surgery.
Most patients could travel back to work three hebdomads after surgery.
Discussion: –
The survey conducted by Kim et Al revealed that early varicocelectomy fix particularly for big varicocele may be good in forestalling future sterility every bit good as intervention of androgen lack ( 7 ) . Pathophysiologic consequence of varicocele on spermatogenesis is related to testicular hyperthermy. ( 8 ) . Fujjsawa et al,1994 support the theory of reflux of toxic metabolites from nephritic and adrenal secretory organs secondary to venous reflux have been implicated to hypospermatogenesis. ( 9 ) .
Skoog et al consider that the testicular hypoxia is caused by venous stasis in varicocele. ( 10 ) . Marcello Cocuzza et Al found that the betterment of seeds parametric quantities following varicocelectomy aid infertile people to accomplish self-generated gestation ( 4 ) .
Ali Shamsa et Al found that the laparoscopic has more complications than unfastened attack sing operative clip, return and hydrocele formation ( 5 ) .
The correlativity between badness of Varicocele and betterment of seeds parametric quantities after surgery remains ambiguous. ( 6 ) .
Andrade et al behavior a survey on 143 patients with varicocele found that sperm quality is affected more than sperm measure in all male age groups. ( 11 ) .
Cayan et Al ( 4 ) showed that unfastened microsurgical inguinal or subinguinal varicocelectomy techniques have been shown to ensue in higher self-generated gestation rates and less return.
Treatment options for Varicocele in sterile work forces may be treated with many different modes including radiologic, laparoscopic and unfastened surgical attacks ( 7, 8, 9, and 10 ) . Postoperative consequences for birthrate suggest that Varicocele fix significantly increase sperm motility and entire sperm count postoperatively ( 11 ) . Spontaneous gestation rate after varicocelectomy scope from 16 % to 55.2 % ( 12 ) . In the meta-analysis reviewed by Kim et Al, the overall self-generated gestation rate was 37.69 % in the Paloma technique series ( 7 ) , which was higher than our consequences. However, self-generated gestation rates after varicocelectomy may differ depending on station surgery follow up interval, the presence of female factors and other generative wellness factors ( 1 ) .
However ; self-generated gestation rate for patients with Varicocele and unnatural seeds parametric quantities estimated to be 10 % which was lower than our consequences. Ishikawa T et Al ( 12 ) assessed the result of Varicocelectomy in the initiation of spermatogenesis and they noticed that surgery for varicocele enhance spermatogenesis for several work forces with unobustructive or terrible oligospermia.
Other surveies confirmed no benefit of varicocelectomy over anticipant direction in subfertile twosomes in whom Varicocele is the lone unnatural determination ( 13, 14 ) .
Further analytical follow-up surveies utilizing Doppler ultrasound for the diagnosing of varicocele with a larger figure of patients is needed.
Decision: –
Varicocelectomy is safe, effectual and associated with a rapid recovery and minimum morbidity. Varicocelectomy resulted in the initiation or sweetening of spermatogenesis to several work forces with clinical Varicocele and unnatural seeds parametric quantities. Despite the absence of unequivocal surveies on the sterility result of Varicocele surgery, it is sensible to be considered as an option in selective patients with semen abnormalcies.
