Predictive Value of Vein Diameter Threshold and Clinical Factors in Semen Quality Improvement after Varicocelectomy

To evaluate whether preoperative varicocele vein diameter predicts postoperative semen quality improvement after microsurgical varicocelectomy, to identify a threshold value, and to assess the influence of age and venous reflux on these associations.

A descriptive cohort study. Place and Duration of the Study: Department of Urology, Manisa Celal Bayar University, Manisa, Turkiye, between June 2010 and August 2025.

A total of 108 men aged 18-40 years with unilateral left-sided varicocele who underwent subinguinal microscopic varicocelectomy for infertility were included; predefined exclusions were applied. Semen parameters [progressive motility, total sperm count, and Sperm Motility Index (SMI)] were averaged from two preoperative tests and compared with the best value at postoperative 6-12 months. The effects of vein diameter, age, and venous reflux on these outcomes were assessed using chi-squared, Mann-Whitney U, and Spearman tests. ROC analysis evaluated vein diameter as a predictor. A p-value of <0.05 was considered statistically significant.

Larger preoperative vein diameter was associated with ≥40% motility improvement (p = 0.045) and ≥420% SMI improvement (p = 0.049). Receiver operating characteristic (ROC) analysis identified a 3.4 mm cut-off value for both motility and SMI, with AUC 0.61 and 0.63, respectively. Venous reflux correlated with greater motility improvement (p = 0.015), while older age correlated with SMI improvement (p = 0.019).

Preoperative vein diameter predicts improvement in progressive motility and SMI after microscopic varicocelectomy; a 3.4 mm threshold shows modest discriminative ability. Venous reflux and age influence specific outcomes and may help guide counselling.

Varicocele, Veins, Semen analysis, Semen quality.