Document Detail


Varicocele repair in patients with nonobstructive azoospermia: a meta-analysis.
MedLine Citation:
PMID:  20400156     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
John W Weedin; Mohit Khera; Larry I Lipshultz
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Publication Detail:
Type:  Journal Article; Meta-Analysis     Date:  2010-04-18
Journal Detail:
Title:  The Journal of urology     Volume:  183     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-13     Completed Date:  2010-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2309-15     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA. weedin@bcm.edu
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MeSH Terms
Descriptor/Qualifier:
Azoospermia / etiology*,  surgery*
Humans
Male
Varicocele / complications,  surgery*
Comments/Corrections
Comment In:
J Urol. 2010 Jun;183(6):2315   [PMID:  20400128 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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