[Laparoscopic varicocele ligation. The comparative assessment of artery-ligating and artery-preserving...

For over ten years more and more significant role in the diagnostics and clinical treatment of marital infertility have been ascribed to the male factor, which accounts for 30-40% of infertility cases. One of the most common reasons of male infertility is varicocele. Between the years 1994-2000 transperitoneal laparoscopic varicocelectomy was performed in 166 men with unilateral varicoceles. Two methods of surgical correction were administered. In I group--88 men (53%)--testicular artery and vein were ligated, in II group--78 men (47%) only testicular vein was ligated. The success of the treatment was evaluated in two age groups; A--19-30 and B--31-41 years of age. Before the operation in group I and II the sperm count was respectively 18.19?10.51 and 19.05 +/- 10.62 x 10(6)/ml. The percentage of the progressive motility was 18.95 +/- 9.46% in I group and 20.12 +/- 9.08% in II group. The percentage of normal forms was 22.04 +/- 8.42% in I group and 23.02 +/- 9.81% in II group. After 12 months of surgical observation the sperm count was 35.21 +/- 13.46 in I and 31.82 +/- 12.14 x 10(6)/ml, in II group. The percentage of progressive motility increased to 36.48 +/- 15.76% in I group and to 31.26 +/- 10.78% in II group. In both groups the percentage of normal forms was comparable, in I group was 49.11 +/- 26.72% and in II group was 47.15 +/- 17.18%. In both age groups sperm count before operation was respectively: 20.42 +/- 10.20 in A, and 16.42 +/- 9.16 x 106/ml in B. The percentage of progressive motility was in A and B respectively 22.98 +/- 9.91% and 15.38 +/- 9.66%. At percentage of normal forms was respectively 25.62 +/- 8.92 and 18.81 +/- 7.93%. In the end of observation period the improvement of sperm count was observed in A--42.69 +/- 22.36, in B--22.86 +/- 11.76 x 10(6)/ml. The improvement of progressive motility was ia A--43.27 +/- 23.96% and in B--23.09 +/- 17.01%. The improvement of normal forms were in A--55.39 +/- 24.31% and 39.69 +/- 22.29 in group B. The pregnancy rate was; in I group +/- 30.6% in II group--23.1%, in A group--33.3%, in B--group--19.7%. The laparoscopic ligation of the testicular vein and artery produced better improvement of semen characteristics and percentage of pregnancies in comparison with artery sparing technique. The laparoscopic varicocelectomy regardless of the technique allows a significant improvement of semen characteristics and pregnancy rate among the couples, where men were less than 30 years of age.