Significance of Microsurgical Varicocelectomy for Non- obstructive Azoospermic Patients

Kim, Sang Hyun; Lee, Joong Shik; Seo, Ju Tae

Abstract

PURPOSE: This study attempted to assess the treatment outcomes after microsurgical varicocelectomy in non-obstructive azoospermic patients and correlate the surgical outcomes with the histopathological patterns of their testes.
MATERIALS AND METHODS
Fourteen non-obstructive azoospermic men who underwent testicular biopsy and varicocelectomy, between September 2001 and December 2002, were reviewed. Varicocelectomy was unilaterally and bilaterally performed in 12 and 2 patients, respectively, using an inguinal approach with a microsurgical technique. Postoperative semen analyses were performed in each patient four months after the varicocelectomy.
RESULTS
In the testicular histology, hypospermatogenesis was identified in three, maturation arrest in five and Sertoli-cell-only syndrome in six of the subjects. After a mean follow-up of 7.4 months, motile sperm in the ejaculate was identified in 6(43%) of the non-obstructive azoospermic patients. These included 2 in hypospermatogenesis, 3 in maturation arrest and 1 in Sertoli-cell-only syndrome, in terms of their histopathology. These six had improvements in their sperm concentration and motility, which were 0.45x10(6)/ml and 51.3%, respectively. However, of these six, with motile sperm after varicocelectomy, 1 with maturation arrest and 1 with Sertoli-cell-only syndrome returned to their previous azoospermic state on their second postoperative semen analyses. A pregnancy was achieved by natural intercourse for 1 of the men(7.1%) with hypospermatogenesis.
CONCLUSIONS
Microsurgical varicocelectomy offers non-obstructive azoospermic patients the chance to have sperm in their ejaculate, and therefore, the possibility of natural pregnancy. Microsurgical varicocelectomy may be considered with the initial treatment modality in selective non- obstructive azoospermic patients with varicocele prior to intervention with assisted reproductive technology.