Effect Of Subinguinal Microsurgical Varicocelectomy On The Improvement Of Total Motile Sperm Count And Sperm Morphology And Its Predictive Factors

Object:To research the improvement of sperm morphology and total motile sperm count and its predictive factors in patients with varicocele after the Sub-inguinal Microsurgical Varicocelectomy.Methods:A total of 102 patients who visited our department and underwent the Sub-inguinal Microsurgical Varicocelectomy from April 2017 to October 2019 was enrolled into our retrospective analysis.The sperm parameter and sperm morphology test were done and been recorded before and after the operation.Compare the results to analysis the improvement of sperm morphology after the Surgery.and utilize the unilateral and bilateral patients’ date to research the difference in the sperm detection parameters before and after surgery.Nine predictive factors including age,BMI,course of disease,smoking,sides,testicular volume,preoperative total motile sperm count(TMSC),the number of ligated veins,the number of reserved arteris were included to analyze their prediction of postoperative sperm morphology improvement effect.Nine predictive factors including age,BMI,course of disease,smoking,sides,testicular volume,preoperative normal morphology rate,the number of ligated veins,the number of reserved arteris were included to analyze their prediction of postoperative TMSC improvement effect.Results: Subinguinal microsurgical varicocelectomy significantly improved TMSC and sperm morphology(normal morphology ratio,TZI,SDI),and the difference was statistically significant before and after surgery(p<0.05).Preoperative unilateral TMSC was higher than bilateral TMSC.And the results of postoperative reexamination of bilateral TMSC were similar to unilateral.There was no statistically significant difference in other semen parameters of patients with single and bilateral varicocele before surgery,and the improvement of TMSC of patients with bilateral varicocele was significantly higher than that of patients with unilateral varicocele after surgery.There was no statistically significant difference in the detection of other semen parameters.Multivariate Logistic regression analysis showed that age ≤28.5 years old and bilateral testicular volume ≥26.5ml could be used as preoperative predictors of sperm morphological improvement after surgery(p<0.01).Unilateral and bilateral varicocele can be used as predictors of postoperative TMSC improvement.Conclusion: The Sub-inguinal Microsurgical Varicocelectomy can improve semen parameters in patients with varicocele(TMSC)and sperm morphology,bilateral testicular volume acuity 26.5 ml and age 28.5 years or less can be used as microscopic spermatic vein ligation predictor of postoperative improve sperm morphology,single and double side varicocele can be used as a predictor of postoperative TMSC improve,bilateral TMSC postoperative improvement is more obvious.