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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.


  1. Bablok L, Czaplicki M, Fr±cki S et al: Relationship between Semen Quality Improvement after Varicocelectomy and Preoperative Levels of Hypophyseal and Gonadal Hormones. Int Urol and Nephrol 1997; 29 (3); 345-9.
  2. Dubin L, Amelar RD: Varicocelectomy: Twenty-five years of experience. Int J Fertil 1988; 33; 226-230.
  3. Czaplicki M: Wpływ leczenia operacyjnego żylaków powrózka nasiennego na stan nasienia ? porównanie dwóch metod operacyjnych. Praca habilitacyjna, Warszawska Akademia Medyczna, 1994.
  4. Goldstein M, Gilbert BR, Dicker AP et al: Microsurgical inguinal varicocelectomy with delivery of the testis: An artery and lymphatic sparing technique. J Urol 1992; 148; 1808-1811.
  5. Parrott TS, Hewatt L: Ligation of the testicular artery and vein in adolescent varicocele. J Urol 1994; 152; 791-793.
  6. Marmar J, Benoff S: New scientific information related to varicoceles. J Urol 2003; 170; 2371-2373.
  7. Forti G, Krausz C, Cilotti A, Maggi M: Varicocele and infertility. J Endocrinol Invest 2003; 26; 564-569.
  8. Templeton A: Varicocele and infertility. Lancet 2003; 361; 1838-1839.
  9. Dhabuwala CB, Hamid S, Moghissi KS: Clinical versus subclinical varicocele: improvement in fertility after varicocelectomy. Fertil Steril 1992; 57 (4); 854-857.
  10. Tuloch WS: Varicocele in subfertility, Results of treatment. J Urol 2002; 167; 1184-1185.
  11. Donovan JF, Winfield HW: Laparoscopic varix ligation. J Urol 1992; 147; 77-81.
  12. Cozzolino DJ, Lipshultz L: Varicocele as a progressive lesion: positive effect of varicocele repair. Human Reprod Update 2001; 7; 55-58.
  13. World Health Organization: The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril 1992; 57 (6); 1289-93.
  14. Ahlberg NE, Bartley O, Chidekel N: Right and left gonodal veins: An anatomical and statistical study. Acta Radiol Stockh 1966; 4; 593-9.
  15. Matsuda T, Horii Y, Higashi S et al: Laparoscopic varicocelectomy: A simple technique for clip ligation of the spermatic vessels. J Urol 1992; 147; 636-638.
  16. Cockett ATK, Takihara H, Cosentino MJ: The varicocele. Fertil Steril 1984; 41 (1); 5-11.
  17. Grasso M, Lania C, Castelli M et al: Bilateral varicocele: impact of right spermatic vein ligation on fertility. J Urol 1995; 153; 1847-1848.
  18. McClure RD, Hricak H: Scrotal ultrasound in the infertile man: Detection of subclinical unilateral and bilateral varicoceles. J Urol 1986; 135; 711-715.
  19. Chiou RK, Anderson JC, Wobig RK et al: Color Doppler Ultrasound Criteria to Diagnose Varicoceles: Correlation of a New Scoring System with Physical Examination. Urology 1997; 50 (6); 953-956.
  20. Kondoh N, Meguro N, Matsumiya K et al: Significance of subclinical varicocele detected by scrotal sonography in male infertility: A preliminary report. J Urol 1993; 150; 1158-11560.
  21. Kass EJ, Marcol B: Results of varicocele surgery in adolescents: A comparison of techniques. J Urol 1992; 148; 694-696.
  22. Matsuda T, Horii Y, Yoshida O: Should the testicular artery be preserved at varicocelectomy? J Urol 1993; 149; 1357-1360.
  23. Iselin CE, Almagbaly U, Borst F et al: Safety and efficiency of laparoscopic varicocelectomy in one hundred consecutive cases. Urol Int 1997; 58; 213-217.
  24. Steckel J, Dicker AP, Goldstein M: Relationship between varicocele size and response to varicocelectomy. J Urol 1993; 149; 769-771.
  25. Ross LS, Ruppman N: Varicocele vein ligation in 565 patients under local anesthesia: a long-term review of technique, results and complications in light of proposed management by laparoscopy. J Urol 1993; 149; 1361-1363.
  26. Yamamoto M, Tsuji Y, Ohmura M et al: Comparison of artery-ligating and artery-preserving varicocelectomy: effect on post-operative spermatogenesis. Andrologia 1995; 27; 37-40.
  27. Ralph DJ, Timoney AG, Parker C, Pryor JP: Laparoscopic Varicocele Ligation. Br J Urol 1993; 72; 230-233.


Jacek Huk
Katedra i Klinika Urologii ¦AM
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41-800 Zabrze
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