Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia


Submitted: June 21, 2020
Accepted: August 24, 2020
Published: December 21, 2020
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Authors

  • Georgios Tsampoukas U-merge Ltd. (Urology for emerging countries), London, UK; Department of Urology, Princess Alexandra Hospital, Harlow, UK; Department of Urology, Agios Andreas Hospital, Patras, United Kingdom.
  • Athanasios Dellis U-merge Ltd. (Urology for emerging countries), London; Department of Urology, Aretaieion Academic Hospital, Athens, Greece.
  • Antigoni Katsouri Department of Pharmacy, University of Patras, Patras, Greece.
  • Dominic Brown Department of Urology, Princess Alexandra Hospital, Harlow, United Kingdom.
  • Konstantinos Deliveliotis 2nd Department of Urology, University Hospital of Athens, Athens, Greece.
  • Mohamad Moussa Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon.
  • Noor Buchholz U-merge Ltd. (Urology for emerging countries), London, United Kingdom.
  • Athanasios Papatsoris U-merge Ltd. (Urology for emerging countries), London; 2nd Department of Urology, University Hospital of Athens, Athens, Greece.

Introduction: In comparison to its clinical analogue, the subclinical varicocele represents a questionable entity and specific guidelines for the optimal management are lacking. In our previous study of patients with subclinical varicocele, we showed that bilateral condition is associated with risk of dyspermia. In the present study, we evaluated the risk of deterioration of semen quality in men with bilateral disease and impaired motility according to WHO criteria. Materials and methods: Men with bilateral subclinical varicocele, not desiring fatherhood at the time of presentation, were included in study. During initial evaluation, the number of Total Motile Sperm Count (TMSC) was calculated and the patients’ age, total testicular volume (TTV), maximum venous size and mean resistive index (RI) of the intratesticular arteries were recorded. We classified the participants in five classes according to the TMSC reading: class A-: TMSC < 5 x 106, class A: TMSC between 5-10 x 106, class B: TMSC between 10-15 x 106, class C: TMSC between 15-20 x 106, and class D: TMSC > 20 x 106 per ejaculate. The participants were seen after 6 months for a repeat spermiogram and physical examination. If clinical varicocele was diagnosed or a new abnormality in the spermiogram was noted, the participants were excluded from the study. The remaining patients were allocated to two groups according to the repeat TMSC reading: patients sub-classified into a lower class (group 1), and patients remaining at the same class (group 2). A comparative analysis was performed between two groups. Results: Nineteen men were included. Nine patients were subclassified (group 1). Three patients moved to A- class (< 5 x 106). Ten patients remained in the same class having no deterioration (group 2). Comparing the two groups, no statistically significant difference was recognized for age, TTV, maximum venous size on both sides, and mean RI (p > 0.05). However, the initial reading for TMSC was 14.57 x 106 in group 1, and 22.84 x 106 in group 2, respectively. This difference was statistically significant (p < 0.05). Additionally, in a paired analysis there was a significant difference in TMSC after 6 months (p < 0.05), too. Summary Conclusions: Young men with bilateral varicocele and asthenospermia seem to be at risk of deterioration in their semen quality after a follow-up of 6 months. The measurement of TMSC can unmask patients at risk, whereas men with the lowest readings seem to be at highest risk for deterioration. The possibility of a worsening sperm quality should be considered in the appropriate clinical context.


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Athanasios Dellis, U-merge Ltd. (Urology for emerging countries), London; Department of Urology, Aretaieion Academic Hospital, Athens

Literature search, writing, editing

Tsampoukas, G., Dellis, A., Katsouri, A., Brown, D., Deliveliotis, K., Moussa, M., Buchholz, N., & Papatsoris, A. (2020). Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia. Archivio Italiano Di Urologia E Andrologia, 92(4). https://doi.org/10.4081/aiua.2020.4.366

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