P-054 Impact of age and correction timing on the progression of testicular dysfunction in patients with grade 3 varicocele
Authors: Elbardisi H , Arafa M , Mahdi M , Khalafallah K , Alsaid S , Majzoub A 
Published: June 2022

Abstract

Study question
Does varicocele lead to progressive testicular dysfunction If not corrected and Can patients with long history of varicocele benefit from varicocelectomy?

Summary answer
Varicocele in older patients have more pronounced effect. Correction at a younger age leads to more significant improvement in testicular function and semen parameters.

What is known already
Varicocele is present in up to 20% of the general adult male population and is more prevalent in men with primary (40%) or secondary infertility (80%). This clinical condition is mostly asymptomatic but can present with persistent scrotal pain in about 10% of cases. More importantly, varicocele has detrimental effect on testicular function due to several pathophysiologic mechanisms including hyperthermia, tissue ischemia, oxidative stress, and reflux of adrenal metabolites.
Microsurgical varicocelectomy is considered the gold standard technique with least side effects compared to other modalities. Varicocelectomy is directly associated with improvements in pain and semen parameters and fertility potential.

Study design, size, duration
This retrospective study was approved by the ethics committee at Hamad Medical Corporation, Doha, Qatar, and has obtained a waiver of informed consent. Records of 1500 patients undergoing microsurgical subinguinal varicocelectomy between January 2017 and July 2020 were collected.

Participants/materials, setting, methods
The inclusion criteria were infertile patients who presented with a clinical grade 3 varicocele. Patients who were azoospermic or severe oligozoospermic, had genetic abnormalities or received prior infertility medical treatment were excluded. Also, patients with prior history of varicocelectomy, orchidopexy or exposure to gonadotoxins were also excluded. Patients were divided in 2 groups according to age, &lt;40years and &gt; =40years. The preoperative semen analysis and hormonal profile pre-surgery and 6 months post-surgery were collected.

Main results and the role of chance
265 patients met the inclusion criteria and were therefore enrolled for data analysis. 210 patients were &lt;40 years and 55 patients &gt;/=40 years at the time of varicocelectomy. The patients' mean age was 33.8±8 years.
Older age was found to be significantly correlated with count (-1.42), total motility (-0.166), progressive motility (-0.193), normal morphology (-0.035), FSH (-0.255) and testosterone (-0.204).
Comparing the preoperative results between the groups, older patients (&gt;/=40years) showed significantly lower values of total motility (39% vs 48.5% P = 0.04), progressive motility (7%vs 20% P = 0.0004), FSH (4 vs 3 P = 0.005) and testosterone (14.1 vs 17.1 P = 0.002) compared with younger patients.
Compared with pre operative parameters, the post operative results in patients &lt;40years showed significant improvement in sperm concentration (33 vs 26.9 p = 0.009), total motility (55% vs 48.5% p &lt; 0.001) and progressive motility (23.5% vs 20% p = 0.022). However, in patients &gt;/=40years, only progressive motility improved significantly (17% vs 7% p = 0.044).
By comparing the post-operative results between the groups, the improvement was significantly better in patients &lt;40years regarding total motility (p = 0.01), progressive motility (p = 0.02) and FSH (p = 0.002).

Limitations, reasons for caution
Retrospective nature
Limited number if cases

Wider implications of the findings
Varicocele will lead to progressive testicular dysfunction if not corrected at younger age

Trial registration number
not applicable