Venous tension patterns in cord veins. II. After varicocele correction

We studied 60 patients to evaluate the success of surgical correction of varicocele in lowering the venous tension in cord veins and to define the relationship of venous tension improvement to restoration of testicular function. Preoperative semen examination, testicular biopsy and venous tension measurements were performed. All patients had venous hypertension and reflux in the left cord. Venous tension was normal on the right side except in 6 patients with venous hypertension despite absent cord varicosities and reflux. An operation was done on the left side in all patients. Postoperative venous tension measurements and semen examination were performed. Of the 53 patients with improved venous tension postoperatively 39 had normal sperm counts with 17 resultant pregnancies. The semen quality in the 7 patients with persistent venous hypertension on the left side did not change except after surgical revision, which resulted in marked improvement in 4 patients with 2 pregnancies. The postoperative venous tension in the right cord veins remained normal. The 6 patients with venous hypertension on the right side had no change until an operation lowered the venous tension to normal, with subsequent improvement in semen quality in 4. The importance of varicosity and reflux in the evaluation of postoperative venous tension is emphasized. The factors involved in the prognosis after varicocele correction are mentioned. The cause of nonimprovement of semen character after a varicocele operation despite normalization of venous tension is discussed. The indications for postoperative venous tension measurement are outlined.