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The impact on fertility of bilateral and left varicocelectomy in infertile men with left clinical and right infra-clinical varicoceles: a comparative study

Ouanes, Y1; Sellami, A1; Chaker, K1; Bibi, M1; Mrad Dali, K1; Ben Chehida, MA1; Ben Rhouma, S1; Nouira, Y1

1: La Rabta University Hospital, Tunisia

Objectives: Although the progress in diagnosis methods revealed a high incidence of infra-clinical varicocele, the clinical signification of this pathology is controversial. In this work, we compare left unilateral varicocelectomy to bilateral surgery in patients with left clinical varicocele associated to an infra-clinical right one.

Material and methods: It is a retrospective study conducted between January 2007 and December 2015 concerning men followed for a varicocele related infertility (one-year or more primary infertility) with two altered sperm analysis (oligospermia and/or asthenospermia) and have had a left clinical varicocele associated to right infra-clinical one detected at Doppler Ultrasound. Surgical techniques used were open surgery (sub-inguinal way), antegrade sclerotherapy and coelioscopy. All patients were reviewed with a 6 month post operatively spermogram and minimum follow up of 1 year.

Results: Our study included 95 men. Thirty five patients have had a unilateral left surgery (Group I) and 60 patients have had a bilateral surgical treatment (Group II). The pre-operative spermatic parameters (concentration and progressive mobility) were comparable for the 2 groups. After the surgical treatment, an improvement of these parameters was noted in all the patients without significant difference between the two groups regarding sperm concentration (24,07±9,36 x106/mL Vs 23,29±3,88 x106/mL) and their progressive mobility (30,47±9,04 % Vs 32,39±9,54 %). The spontaneous pregnancy rate was 30% for patients in group I and 36.6% for those in group II without any statistically difference (p = 0.68).

Conclusion: We did not find any interest in performing a right subclinical varicocele in a patient with a clinical left varicocele in term of spontaneous pregnancy.


Work supported by industry: no.

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