Varicocele Repair in Patients With Nonobstructive Azoospermia: A Meta-Analysis

No AccessJournal of UrologyAdult Urology1 Jun 2010Varicocele Repair in Patients With Nonobstructive Azoospermia: A Meta-Analysis John W. Weedin, Mohit Khera, and Larry I. Lipshultz John W. WeedinJohn W. Weedin Nothing to disclose. More articles by this author , Mohit KheraMohit Khera Financial interest and/or other relationship with Allergan, Auxilium, Coloplast and Slate Pharmaceuticals. More articles by this author , and Larry I. LipshultzLarry I. Lipshultz Financial interest and/or other relationship with Allergan, Auxilium, Pfizer, Lilly, AMS and Vivus. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.012AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Multiple small case series have reported sperm in the ejaculate and spontaneous pregnancies in patients with nonobstructive azoospermia after varicocele repair. We hypothesized that men with favorable testicular histopathology on testis biopsy such as maturation arrest or hypospermatogenesis would have a higher probability of success than those with more ablative pathology, eg Sertoli-cell-only. Materials and Methods: A review of the literature on varicocele repair in patients with nonobstructive azoospermia was performed and 11 publications from the previous 20 years were evaluated. Histopathological data were presented in 8 publications, and were categorized as Sertoli-cell-only, maturation arrest and hypospermatogenesis. Maturation arrest was further differentiated by 4 publications. Early maturation arrest was defined as maturation ending at the secondary spermatocyte and late maturation arrest was defined as maturation ending at the spermatid without spermatozoa present. Success after repair was defined as having sperm in the ejaculate or spontaneous pregnancy. Results: A total of 233 patients were analyzed. After varicocele repair 91 (39.1%) patients had motile sperm in the ejaculate and 14 spontaneous pregnancies were reported. Success rates in patients with maturation arrest (42.1%) or hypospermatogenesis (54.5%) were significantly higher than in those with Sertoli-cell-only (11.3%, p <0.001 in both groups). Patients with late maturation arrest had a higher probability of success (45.8%) than those with early maturation arrest (0%, p = 0.007). Conclusions: Infertile men with nonobstructive azoospermia can have improvement in semen analysis and achieve spontaneous pregnancy after repair of clinical varicoceles. This meta-analysis demonstrates that men with late maturation arrest and hypospermatogenesis have a higher probability of success and, therefore, histopathology should be considered before varicocele repair in men with nonobstructive azoospermia. References 1 : Declining estimates of infertility in the United States: 1982–2002. Fertil Steril2006; 86: 516. 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Link, Google Scholar Scott Department of Urology, Baylor College of Medicine, Houston, Texas© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byClavijo R, Bakircioglu E and Ramasamy R (2017) Re: Predictive Factors for Sperm Recovery after Varicocelectomy in Men with Nonobstructive AzoospermiaJournal of Urology, VOL. 198, NO. 2, (446-447), Online publication date: 1-Aug-2017.Shiraishi K, Oka S and Matsuyama H (2016) Predictive Factors for Sperm Recovery after Varicocelectomy in Men with Nonobstructive AzoospermiaJournal of Urology, VOL. 197, NO. 2, (485-490), Online publication date: 1-Feb-2017.Sigman M (2011) Varicoceles and Treatment of Infertility—Have We Made Any Progress?Journal of Urology, VOL. 187, NO. 1, (13-14), Online publication date: 1-Jan-2012.Abdel-Meguid T (2011) Predictors of Sperm Recovery and Azoospermia Relapse in Men With Nonobstructive Azoospermia After Varicocele RepairJournal of Urology, VOL. 187, NO. 1, (222-226), Online publication date: 1-Jan-2012.Weedin J, Bennett R, Fenig D, Lamb D and Lipshultz L (2011) Early Versus Late Maturation Arrest: Reproductive Outcomes of Testicular FailureJournal of Urology, VOL. 186, NO. 2, (621-626), Online publication date: 1-Aug-2011. Volume 183Issue 6June 2010Page: 2309-2315 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordspathologyvaricoceleinfertility, maletestisazoospermiaMetricsAuthor Information John W. Weedin Nothing to disclose. More articles by this author Mohit Khera Financial interest and/or other relationship with Allergan, Auxilium, Coloplast and Slate Pharmaceuticals. More articles by this author Larry I. Lipshultz Financial interest and/or other relationship with Allergan, Auxilium, Pfizer, Lilly, AMS and Vivus. More articles by this author Expand All Advertisement PDF downloadLoading ...