Comparative evaluation of the effect of laparoscopic treatment of unilateral and bilateral varicoceles testis on the improvement of fertility in men
Article published in Urologia Polska 2005/58/2.
Jacek Huk, Mieczysław Fryczkowski, Andrzej Kupilas
- Katedra i Klinika Urologii ¦l±skiej Akademii Medycznej w Zabrzu
Kierownik katedry i kliniki: prof. dr hab. Mieczysław Fryczkowski
varicocele testis, infertility in men, laparoscopy
- introduction and aim of the study
- Many reports suggest that male factor plays an important role in the diagnosis and treatment of marital infertility. One of its most frequenty causes are varicoceles testis.
- materials and methods
- In years 1995-2004 correcive surgery was performed in 564 men with varicoceles using the technique of ligation of both testicular vein and artery and testicular vein only
- Results. In the group of men with unilateral varicoceles the average sperm count increased from 19,24 ?9,87 x 106 /ml to 33,42 ?12,16 x 106 /ml. In the group of men with bilateral varicoceles increased from the average 17,22 ?8,82 x 106 /ml to 56,13 ?19,82 x 106 /ml in the final period of observation after the surgery. In the group of men with unilateral varicoceles the average percentage of progressive motile sperm increased from 19,20 ?9,62% to 33,26 ?14,27%. In the group of men with bilateral varicoceles improvement of this parameter was observed from the average 19,22 ?9,42% before the surgery to 55,18 ?22,12% in the final period of observation. In both groups of men with unilateral varicoceles improvement of the percentage of properly formed sperm was 22,16?10,12% and increased to the average 49,22 ?12,62%. In the group of men with bilateral varicoceles the average percentage of properly formed sperm was 20,81 ?9,11% and after the surgery is was 68,12 ?20,32%. In the group of 307 couples with men operated on the one side 22,1% pregnancies were obtained in 81 couples. In the group of 197 marriages with bilateral corrective surgery of varicoceles 42,6% pregnancies were present in 84 marriages.
- Bilateral laparoscopic corrective surgery of varicocele enables to obtain significantly higher improvement of sperm density, percentage of sperm in translatory motion, properly formed sperm as well as twice as much percentage of pregnancies among infertile couples in comparison to surgeries of unilateral varicoceles. Laparoscopic ligation of both testicular vein and artery in men with unilateral varicoceles enables to obtain significantly higher improvement of sperm quality as well as nonsignificantly higher percentage of pregnancies among couples in comparison to the methods sparing testicular artery. In the group of men with bilateral varicoceles significantly higher improvement in the percentage of sperm in translatory motion as well as properly formed sperm together with comparable percentage of pregnancies were obtained regardless of the technique.
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