Internal spermatic vein diameter and age at operation reflect the response to varicocelectomy

It was evaluated whether the diameter of internal spermatic veins (measured directly during operation) correlates with the clinical grade and treatment outcome following varicocelectomy. Fifty-seven consecutive men undergoing left varicocelectomy were included in the study, and spermatic vein diameter was compared with the response to the operation. The diameter appeared larger with increasing clinical grade (subclinical: 3.40 +/- 1.64 mm; grade 1 : 2.74 +/- 0.84 mm; grade 2 : 3.70 +/- 1.09 mm; grade 3 : 4.38 +/- 1.30 mm). In patients 30 years or older, spermatic vein diameter in men whose post-operative semen parameters were unchanged or worsened was statistically larger than that of patients whose post-operative semen parameters were improved, in terms of both sperm concentration (3.90 +/- 1.24 mm versus 2.84 +/- 0.94 mm; P < 0.05) and sperm motility (3.98 +/- 1.24 mm versus 2.67 +/- 0.67 mm, P < 0.01). Although the diameter of internal spermatic veins measured directly during operation correlated well with clinical grade, it is the diameter and patient's age at operation, but not clinical grade, that determine the reversibility of testicular injury following varicocelectomy.