The testicular biopsy and spermatogenesis disturbance of infertile patients with bilateral varicocele.

In this article we describe the examination and the results obtained in 221 patients subjected to surgical intervention, i.e. microsurgical bilateral varicocele or to the conventional Ivanisevich technique and systematic multiple and bilateral testicular biopsy at the scrotal examination. Testicular biopsy (TB) has been executed according to the microsurgical protocol in a standard way; in each of the testicles two different quadrants. Upper-internal and lower-external quadrants were used to establish the qualitative mean index. According to concentration of spermatozoa per milliliter of the sperm the patients were classified into 5 different biological groups: I group--azoospermia or extreme oligozoospermia 93 patients, II--severe oligozoospermia 43 patients, III--moderate oligozoospermia 23, IV--relative oligozoospermia 18, and V group--normozoospermia 44 patients. The results of testicular biopsies have been evaluated according to the biological group. In the group with azoospermia and the extreme oligozoospermia the TB has determined the degree of the spermatogenesis derangement in 92 cases, in the majority of cases--50 MA (maturation arrest) + SCOS (Sertoli Cell Only Syndrome) + tubular fibrosis. In many cases hypospermatogenesis is accompanied with MA, SCOS or testicular fibrosis. In this group the semen analysis generally demonstrates different variations of oligospermia. Incidence of maturation arrest was observed in 32 cases of total 221. Among the MA there are 7 cases of early stage spermatocyte I, MA spermatocyte II in 21 patients and MA spermatide (late arrest) in 4 cases. SCOS was observed in 20 patients. All the patients have secretory azoospermia. SCOS is also observed together with other disorders of spermatogenesis. Tubular and peritubular fibrose atrophy was observed in 5 cases. These are the patients with the antecedent criptorchidia.