The efficacy of bilateral varicocelectomy in patients with palpable bilateral varicoceles: comparative study with unilateral varicocele.

To determine whether the beneficial effect of bilateral varicocelectomy for bilateral varicoceles is similar to that of unilateral varicocelectomy for unilateral varicoceles, we compared the effect of varicocelectomy in men with unilateral and bilateral palpable varicoceles. Seventy-five men with unilateral varicocele and 34 with bilateral varicoceles were included in this study. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin, and estradiol were measured in morning blood specimens. Unilateral varicocelectomy was performed for unilateral and bilateral varicocelectomy for bilateral varicoceles using a microsurgical technique. The seminogram was determined every 3 months for up to 18 months. There were no significant differences in the change in the sperm concentration between the unilateral and bilateral groups. Sperm concentration before surgery in unilateral and bilateral group was 8.0+/-5.0x10(6)/ml and 8.1+/-4.9x10(6)/ml, respectively. Eighteen months after surgery, the sperm concentration significantly increased to 23.4+/-15.8x10(6)/ml and 26.9+/-24.6x10(6)/ml in unilateral and bilateral group, respectively. Preoperative motility in the unilateral and bilateral group was 38.9+/-15.2% and 39.6+/-15.7%, respectively. Eighteen months after operation, sperm motility had increased and was similar in the two groups, 43.1+/-19.2% and 45.4+/-17.6%. Sperm morphology was unaffected by surgery in either group. Improvement in the seminogram of patients following bilateral varicocelectomy was comparable to that in patients with unilateral varicocelectomy. Bilateral repair for bilateral varicocelectomies is justified for patients who desire improved spermatogenesis.