Effect of age and grade on surgery for patients with varicocele

To assess the seminal characteristics, hormonal levels, and pathologic findings in patients of various age groups with varicocele before and after ligation to establish the presence of an aging effect in patients with varicocele on those characteristics.

The records were retrospectively evaluated for 70 infertile patients with azoospermia or oligospermia who underwent microsurgical left inguinal varicocele ligation. The mean +/- SD patient age was 33.9 +/- 5.5 years. Left varicocele was detected in 70 patients. We divided our patients into three groups according to age: group 1, 20 to 29 years old (n = 17); group 2, 30 to 39 years old (n = 41); and group 3, older than 40 years (n = 12).

Before ligation, no significant differences were seen among the three groups in luteinizing hormonal level, prolactin level, estradiol level, right testicular volume, semen volume, and sperm concentration and sperm motility. Significant differences were seen in the follicle-stimulating hormonal level, testosterone level, and left testicular volume. After ligation, even in group 3, the sperm concentration and motility increased from 6.38 +/- 5.47 to 13.07 +/- 9.05 million/mL (P = 0.042) and from 28.42% +/- 23.22% to 39.92% +/- 22.06%, respectively. No significantly greater degree of improvement in semen characteristics was observed between grade II and grade III after varicocele ligation.

The results of our study have shown that age is not a significant predictive factor of improvement in semen characteristics before ligation. It is reasonable to perform ligation to improve the semen characteristics in patients older than 40 years old.