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Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men

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Abstract

Purpose

A continuous spermatic venous reflux (SVR) at colour Doppler ultrasound (CDU) is an evidence for varicocele, a frequent correlate for male subfertility. We explored whether SVR after left varicocele repair is predictive for changes in semen quality in subfertile men.

Methods

Blood hormones (FSH, LH, and total testosterone) and scrotal CDU were obtained in subfertile patients with left grade II or grade III varicocele on physical evaluation and a poor sperm quality. Semen analysis and CDU were re-evaluated 6 months after a retrograde internal spermatic vein scleroembolisation.

Results

The retrospective study included 100 men with a baseline SVR >3 cm/s; 60 men showed a disappearance (group 1) and 40 men (group 2) showed a reduced SVR after varicocele repair. Total motile sperm count (TMC) was markedly increased after treatment (p < 0.0001; F = 35.79) and the increase was more relevant in group 1 compared to group 2 (p = 0.04; F = 4.20). TMC and left SVR values after varicocele repair were negatively correlated (R = −0.218; p = 0.035). Multivariate analysis showed that adjusted SVR after repair negatively predicted TMC change (TMC after repair minus baseline TMC) (ß = −2.56; p = 0.022). Disappearance of a continuous left SVR at CDU after varicocele repair was associated to a better improvement of semen parameters in subfertile men.

Conclusion

Recording of a continuous left spermatic vein reflux is an objective method to assess a successful varicocele repair aimed to improve sperm parameters in subfertile men.

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Author notes

  1. S. D’Andrea, A. Micillo and A. Barbonetti contributed equally to the paper.

Authors and Affiliations

  1. Department of Life, Health and Environment Sciences, Andrology Unit, University of L’Aquila, Piazzale Tommasi, 67100, L’Aquila, Italy

    S. D’Andrea, A. Micillo, F. Francavilla & S. Francavilla

  2. San Raffaele Institute, Sulmona, Italy

    A. Barbonetti

  3. University Hospital San Salvatore, Interventional Radiology Unit, L’Aquila, Italy

    A. V. Giordano, S. Carducci & A. Mancini

  4. Department of Epidemiology, University of L’Aquila, L’Aquila, Italy

    S. Necozione

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  1. S. D’Andrea
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  4. A. V. Giordano
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Contributions

SD acquisition of data, drafting the article, analysis and interpretation of data; AM acquisition of data, drafting the article, analysis and interpretation of data; AB acquisition, analysis and interpretation of data; AVG; SG; AM; SN statistical analysis and interpretation of data; FF critical revision for important intellectual content; SF conception and design, analysis and interpretation of data, critical revision for important intellectual content, final approval of the version to be published.

Corresponding author

Correspondence to S. Francavilla.

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Financial support

This work was supported by Ministero dell’Università e della Ricerca Scientifica, Italy.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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D’Andrea, S., Micillo, A., Barbonetti, A. et al. Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men. J Endocrinol Invest 40, 1145–1153 (2017). https://doi.org/10.1007/s40618-017-0695-x

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