Thiago Afonso Teixeira1,2,3,4, Juliana Risso Pariz1,2,3,5, Robertson Torres Dutra1,5, Paulo Hilario Saldiva2,5, Elaine Costa2,3,6, Jorge Hallak1,2,3,5. 1. Division of Urology, Institute for Advanced Studies, University of Sao Paulo, Sao Paulo, Brazil. 2. Men's Health Study Group, Institute for Advanced Studies, University of Sao Paulo, Sao Paulo, Brazil. 3. Androscience - Science and Innovation Center and High-Complexity Clinical and Research Andrology Laboratory, Sao Paulo, Brazil. 4. School of Medicine, Federal University of Amapa, Macapá, Brazil. 5. Reproductive Toxicology Unit, Department of Pathology, University of Sao Paulo, Sao Paulo, Brazil. 6. Division of Endocrinology, University of Sao Paulo, Sao Paulo, Brazil.
Abstract
BACKGROUND: It remains challenging to determine which individuals are likely to benefit from microsurgical correction of subclinical varicocele, as basic semen parameters often do not improve postoperatively. We aimed to develop an easily accessible tool for prognostic stratification of infertile men indicated for microsurgical correction of bilateral subclinical varicocele characterized by prolonged and clear venous reflux and no other cause for infertility. METHODS: We retrospectively analyzed the testicular biopsy, seminal analysis, and ultrasound evaluation records of 20 men managed between 2006 and 2014. Subclinical varicocele was diagnosed through bilateral testicular palpation and auscultation of venous reflux using a Doppler stethoscope, with confirmation on color Doppler sonography. We conducted receiver operating characteristic curve analysis to identify the optimal combinations of cut-offs for the Johnsen score, Copenhagen index, and testicular volume defining histological patterns with positive prognostic value for improved postoperatively reproductive capacity. RESULTS: Positive prognostic value was noted for the following combinations of parameters: (I) Johnsen score >8.2 in the left testicle and right testicular volume >12.8 mL predicted improved sperm concentration; (II) Johnsen score >8.2 and Copenhagen index digit II <2.5 bilaterally predicted improved total sperm motility; (III) Johnsen score >9.1 and Copenhagen index digit III <1.5 bilaterally predicted improved progressive sperm motility; (IV) Johnsen score >7.9 and right testicular volume >13.6 mL predicted improved sperm morphology. CONCLUSIONS: Johnsen score and Copenhagen index as histopathological prognostic factors can be easily obtained upon evaluation of testicular biopsy specimens and can be simple and reliable tool to establish a more realistic prognosis for reproductive capacity in men who undergo microsurgical correction of subclinical varicocele with no other detectable cause for infertility.
BACKGROUND: It remains challenging to determine which individuals are likely to benefit from microsurgical correction of subclinical varicocele, as basic semen parameters often do not improve postoperatively. We aimed to develop an easily accessible tool for prognostic stratification of infertile men indicated for microsurgical correction of bilateral subclinical varicocele characterized by prolonged and clear venous reflux and no other cause for infertility. METHODS: We retrospectively analyzed the testicular biopsy, seminal analysis, and ultrasound evaluation records of 20 men managed between 2006 and 2014. Subclinical varicocele was diagnosed through bilateral testicular palpation and auscultation of venous reflux using a Doppler stethoscope, with confirmation on color Doppler sonography. We conducted receiver operating characteristic curve analysis to identify the optimal combinations of cut-offs for the Johnsen score, Copenhagen index, and testicular volume defining histological patterns with positive prognostic value for improved postoperatively reproductive capacity. RESULTS: Positive prognostic value was noted for the following combinations of parameters: (I) Johnsen score >8.2 in the left testicle and right testicular volume >12.8 mL predicted improved sperm concentration; (II) Johnsen score >8.2 and Copenhagen index digit II <2.5 bilaterally predicted improved total sperm motility; (III) Johnsen score >9.1 and Copenhagen index digit III <1.5 bilaterally predicted improved progressive sperm motility; (IV) Johnsen score >7.9 and right testicular volume >13.6 mL predicted improved sperm morphology. CONCLUSIONS: Johnsen score and Copenhagen index as histopathological prognostic factors can be easily obtained upon evaluation of testicular biopsy specimens and can be simple and reliable tool to establish a more realistic prognosis for reproductive capacity in men who undergo microsurgical correction of subclinical varicocele with no other detectable cause for infertility.
Entities:
Keywords:
Testicular biopsy; male infertility; microsurgery; seminal parameters; subclinical varicocele
Authors: Kelly S Athayde; Marcello Cocuzza; Ashok Agarwal; Natalie Krajcir; Antonio M Lucon; Miguel Srougi; Jorge Hallak Journal: J Androl Date: 2007-04-04
Authors: Marcello Cocuzza; Kelly S Athayde; Ashok Agarwal; Rodrigo Pagani; Suresh C Sikka; Antonio M Lucon; Miguel Srougi; Jorge Hallak Journal: Fertil Steril Date: 2007-11-26 Impact factor: 7.329