Microsurgical inguinal varicocele repair in azoospermic men

Objectives. To evaluate the efficacy of microsurgical inguinal varicocele r epair in nonobstructive azoospermic men with palpable varicocele and to det ermine predictive parameters of outcome. Methods. After standard diagnostic evaluation, 24 pellet(-) completely azoo spermic men and 14 pellet(+) virtually azoospermic men underwent microsurgi cal inguinal varicocele repair. Testicular core biopsy was also performed p erioperatively in all patients. The outcome was assessed in terms of improv ement in semen parameters and spontaneous pregnancy. Results. After a mean follow-up of 13.4 +/- 4.7 months, motile sperm in the ejaculate could be identified in 5 (21%) of the completely azoospermic pat ients, and these patients were rescued from invasive sperm extraction techn iques when referred to intracytoplasmic sperm injection. Testicular histopa thology of these patients with postoperative improvement revealed maturatio n arrest at spermatid stage (n = 3), Sertoli-cell-only (SCO) pattern with f ocal spermatogenesis (n = 1), and hypospermatogenesis (n = 1). None of the patients with pure SCO pattern or maturation arrest at spermatocyte stage h ad improvement after varicocele repair. However, improvement in semen param eters was observed in 12 (85.7%) patients with virtual azoospermia, 4 (28.6 %) achieved a total motile sperm count greater than 5 million, and spontane ous pregnancy occurred with 3 (21.4%) of them. Conclusions. Microsurgical inguinal varicocele repair offers completely azo ospermic men the chance to provide motile sperm via ejaculate in 21%. Moreo ver, 28.6% of virtually azoospermic men are rescued from ICSI procedures as an initial treatment modality. Results of varicocele repair in azoospermic men also reveal that a certain threshold of spermatogenesis, requiring the presence of at least spermatids, is necessary for effective varicocele rep air. UROLOGY 57: 328-333, 2001. (C) 2001:, Elsevier Science Inc.