Paternity after varicocelectomy: preoperative sonographic parameters of success

This study was done to assess the sonographic findings that could predict the outcome of varicocele repair in the treatment of male infertility/subfertility related to varicocele.

This was a retrospective study and follow-up of 107 selected patients with male factor infertility related to the presence of varicocele. The patients were classified into 2 groups according to their estimated testicular size by sonography. Group 1 included 80 patients with normal-sized testes (>15 cm(3)), and group 2 included 27 patients with small testes (10-15 cm(3)). The mean age +/- SD was 34 +/- 11 years. The mean duration of infertility was 3.4 +/- 1.4 years. They had oligospermia, asthenospermia, or oligoasthenospermia. The patients underwent low ligation varicocelectomy and were followed for 18 to 45 months after surgery for occurrence of paternity. Their scrotal sonographic findings were reviewed and correlated with the postoperative paternity rate.

Postoperative paternity was achieved in 24 patients (30%) of group 1 with normal-sized testes and in 3 patients (11%) of group 2 with small testes. In patients of group 1, the positive paternity rate was higher (36.6%) in patients with clinically detected varicocele, compared with only 16% of patients with subclinical varicocele. In addition, postoperative paternity was significantly higher in patients with bilateral varicocele (54.5%; P = .0099), patients with shunt-type varicocele (75%; P = .0117), and patients with a permanent grade of venous reflux (70%; P = .0148). No significant differences were noted between positive paternity rates in patients with mildly or markedly dilated veins.

The best preoperative sonographic parameters of success of varicocele repair are the presence of normal-sized testes, clinically palpable veins, bilateral varicocele, shunt-type varicocele, and a permanent grade of venous reflux. It does not matter how much the veins are dilated.