https://doi.org/10.4081/aiua.2023.11580

Bilaterality of varicocele: The overlooked culprit in male infertility. Case series study

Vol. 95 No. 3 (2023)
Published: September 12, 2023
Male infertility, Varicocele bilaterality, Varicocelectomy, Semen parameters
Abstract Views: 723
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Authors

Khaled Mohamed Almekaty
Urology Department, Tanta University, Tanta, Egypt.
Ahmed Mostafa Elsharkawy
https://orcid.org/0000-0001-9069-5181
Radiology Department, Tanta University, Tanta, Egypt.
Mohamed Hasan Zahran
Mansoura Urology and nephrology centre, Mansoura University, Mansoura, Egypt.
Maged Mostafa Ragab
Urology Department, Tanta University, Tanta, Egypt.
Ayman Sayed Rashed
https://orcid.org/0000-0003-1994-2228
Urology Department, 6th of October University, Cairo, Egypt.
Mahmoud Mohamed Soliman
https://orcid.org/0000-0002-3268-7412
Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.
Khaled Abdelaziz Salem
Urology Department, Tanta University, Tanta, Egypt.
Ahmed Fayez Ghaith
dr_ahmedfayez@yahoo.com
https://orcid.org/0000-0002-9102-1821
Urology Department, Tanta University, Tanta, Egypt.

Objectives: Varicocele is the most common correctable cause of male infertility that always has been a debatable subject as regards how it affects fertility and the best way to treat it. Proper assessment of the disease bilaterality is crucial not to miss one side and not to jeopardize treatment outcome. This study aimed to objectively assess varicocele bilaterality in infertile men aiming to improve treatment outcome in this cohort of patients. Methods: This prospective study was conducted between January 2019 and January 2022 including infertile males with varicoceles. Assessment of missed concomitant contralateral varicocele done pre-operatively by Color Doppler Ultrasound and intraoperatively by intraoperative Doppler device and measurement of maximal vein diameter of contralateral side. Results: A total of 329 cases completed the study. A hundred cases (30.4%) were initially referred as unilateral varicoceles and 229 (69.6%) as bilateral varicoceles. After reassessment of the study population, bilaterality of varicocele was found to be as high as 98.5% (324/329). Repeat CDUS strongly correlated with the intraoperative measured varicocele diameter (r = 0.9, p < 0.001). Moreover, sperm parameters showed significant improvement 3 and 6 months post varicocelectomy. Normal pregnancy after 1 year of surgery occurred in 118 cases (35.9%). Conclusions: Varicocele bilaterality in infertile men is underreported. Thorough assessment by expert radiologists and andrologists is of paramount importance not to miss significant pathology or hazard treatment outcome.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
Sigman M, Jarow JP. Male infertility. In: Walsh PC, Retik AB, Vaughn ED, Wein AJ (eds.), Campbell’s Urology 8th ed. Philadelphia: Saunders 2002; 1475-1532.
Yamaguchi M, Sakatoku J, Takihara H. the application of intrascrotal deep body temperature measurement for the non-invasive diagnosis of varicoceles. Fertil Steril. 1989; 52:295-301. DOI: https://doi.org/10.1016/S0015-0282(16)60858-0
Masson P, Brannigan RE. The varicocele. Urol Clin North Am. 2014; 41:129-144. DOI: https://doi.org/10.1016/j.ucl.2013.08.001
Sabanegh E, Agarwal A. Male infertility, in Campbell-Walsh Urology, A. J. Wein, L. R. Kavoussi, A. C. Novick, and A. W. Partin, Eds., pp. 636-637, Saunders, Philadelphia, Pa, USA, 10th edition, 2012.
Tulloch WS. A consideration of sterility factors in the light of subsequent pregnancies. Edinburgh Med J. 1952; 59:29-34.
Fujisawa M, Ishikawa T, Takenaka A. The efficacy of bilateral varicocelectomy in patients with palpable bilateral varicoceles: comparative study with unilateral varicocele. Urol Res. 2003; 31:407-9. DOI: https://doi.org/10.1007/s00240-003-0361-y
Libman J, Jarvi K, Lo K, Zini A. Beneficial effect of microsurgical varicocelectomy is superior for men with bilateral versus unilateral repair. J Urol. 2006; 176:2602-5. DOI: https://doi.org/10.1016/j.juro.2006.07.161
Gat Y, Bachar GN, Zukerman Z, et al. Varicocele: a bilateral disease. Fertil Steril. 2004; 81:424-9.
Trum J, Gubler F, Laan R, Van der Veen F. The value of palpation, varicoscreen contact thermography and colour Doppler ultrasound in the diagnosis of varicocele. Hum. Rep. 1996; 11:1232-1235. DOI: https://doi.org/10.1093/oxfordjournals.humrep.a019362
Hussein AF. The role of color Doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy. J Urol. 2006; 176:2141-2145. DOI: https://doi.org/10.1016/j.juro.2006.07.009
Paduch D, Niedzielski J. Repair versus observation in adolescent varicocele: a prospective study. J Urol. 1997; 158:1128-32. DOI: https://doi.org/10.1016/S0022-5347(01)64403-3
Gat Y, Bachar GN, Zukerman Z, et al. Varicocele: a bilateral disease. Fertil Steril. 2004; 81:424-9. DOI: https://doi.org/10.1016/j.fertnstert.2003.08.010
Gonda RL Jr, Karo JJ, Forte RA, O'Donnell KT. Diagnosis of subclinical varicocele in infertility. AJR Am J Roentgenol. 1987; 148:71-75. DOI: https://doi.org/10.2214/ajr.148.1.71
McClure RD, Hricak H. Scrotal ultrasound of infertile man: detection of subclinical unilateral and bilateral varicoceles. J Urol. 1986; 135:711-15. DOI: https://doi.org/10.1016/S0022-5347(17)45827-7
Chatel A, Bigot JM, Helenon C, et al. Interet de la phlebographie spermatique dans le diagnostic des sterilites d'origine circulatoire (varicocele). Comparaison avec les donnees cliniques, thermographiques et anatomiques. Ann. Rad. 1978, 21:565.
Gonzalez R, Reddy P, Kaye KW, Narayan P. Comparison of Doppler examination and retrograde spermatic venography in the diagnosis of varicocele. Fertil Steril. 1983; 40:96-9. DOI: https://doi.org/10.1016/S0015-0282(16)47184-0
Cockett ATK, Harrison RM, Comhaire F, Dubin L. The varicocele and its effect on fertility. Contemp Surg 1984; 24:111-14.
Jensen CFS, Østergren P, Dupree JM, et al. Varicocele and male infertility. Nat Rev Urol. 2017; 14:523-533. DOI: https://doi.org/10.1038/nrurol.2017.98
Almekaty K, Zahran MH, Zoeir A, et al. The role of artery-preserving varicocelectomy in subfertile men with severe oligozoospermia: a randomized controlled study. Andrology. 2019; 7:193-198. DOI: https://doi.org/10.1111/andr.12580
Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM. Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Eur Urol. 2011; 59:455-461. DOI: https://doi.org/10.1016/j.eururo.2010.12.008

How to Cite

Almekaty, K. M., Elsharkawy, A. M., Zahran, M. H., Ragab, M. M., Rashed, A. S., Soliman, M. M., Salem, K. A., & Ghaith, A. F. (2023). Bilaterality of varicocele: The overlooked culprit in male infertility. Case series study. Archivio Italiano Di Urologia E Andrologia, 95(3). https://doi.org/10.4081/aiua.2023.11580
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