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Varicocele and reproductive function: pathozoospermia treatment (a prospective comparative study)

V. A. BozhedomovDepartment of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, RussiaA.B. ShomarufovDepartment of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, RussiaG E BozhedomovaDepartment of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, RussiaD.A. Ohobotov OhobotovDepartment of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, RussiaDavid M. KamalovDepartment of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, RussiaН. И. СорокинDepartment of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, RussiaА А КамаловDepartment of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia

2021en

ABI

Annotatsiya

Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. OBJECTIVE: to evaluate the standardized effect (Es) of nutrient therapy, microsurgical and laparoscopic varicocelectomy for pathozoospermia. STUDY DESIGN: a multicenter case-control study with stratified randomization. MATERIALS AND METHODS: data of a clinical and laboratory examination of patients with clinical varicocele over a 3-month period in the groups: A) the observation/control group (n=33), B) the group treated with nutrients (n=63), C) the group of patients after microsurgical varicocelectomy with a subinguinal mini access (n=86), D) the group of patients following laparoscopic surgery (n=36). The ejaculate was evaluated according to WHO-2010, DNA fragmentation by chromatin dispersion in an agarose gel. RESULTS: After 3 months, varicocelectomy leads to an increase in sperm concentration and motility: the median of the total number of progressively motile spermatozoa in the ejaculate in A is +0.4 million; B - +1.9 million; C - +17.1 million (p<0.05); D - +21.2 million (p<0.05). A clinically significant increase in this indicator after varicocelectomy was found in 2/3 of cases: 65% (B; p<0.05) and 67% (G; p<0.05) with 38% (A) and 42% (B). Varicocelectomy leads to a decrease in sperm DNA fragmentation by an average of 5.5% (p<0.05) with an improvement in 59% of patients, but a 3-month therapy with nutrients reduces DNA fragmentation in a similar way: 5.5% (p<0.05), 66% of improvement cases. The differences in effect between B and D are insignificant (p>0.05). The laparoscopic surgery demonstrated higher Es than microsurgical operation (Es=0.70 and 0.44, with 0.29 in the patient receiving nutrients and 0.22 in the patients in the control group) Conclusion Varicocelectomy significantly improves sperm quality in 2/3 of cases, including 5.5% decrease in DNA fragmentation. Nutrient therapy produces similar DNA fragmentation improvement. Further research is necessary to identify who really requires varicocelectomy and who does not.

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DOI: 10.18565/urology.2021.2.62-68

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