| BackgroundVaricocele is a common urological disease with a prevalence rate of 15%～20%,which can lead to male infertility and affect testosterone metabolism.Microscopic surgery and laparoscopic surgery are widely used because of their precise efficacy.However,the efficacy of these two surgical methods is still controversial,and there are few studies on testosterone metabolism and semen quality,so this paper will further explore the above issues.ObjectiveCompare the advantages and disadvantages of the two surgical methods in improving semen quality,improving spermatic vein diameter,relieving scrotal pain and increasing the rate of natural pregnancy.Discuss with scrotal pain or infertility of patients complained of the best operation way.To evaluate the effect of varicocele on testosterone metabolism.MethodsClinical data of patients undergoing varicocele surgery in our hospital from September2017 to August 2022 were collected,including basic clinical information(age and BMI),testosterone level,semen quality,spermatic vein diameter,postoperative complications and recurrence rate,etc.Pain improvement in patients and spontaneous pregnancy rate in infertile patients were collected by telephone follow-up.According to the inclusion and exclusion criteria,319 qualified cases were obtained.According to different surgical methods,137 cases in the microscope group,182 cases in the laparoscopic group.SPSS 22.0 statistical software was used for statistical analysis.The count data were expressed as percentage and chi-square test was used.The measurement data were expressed as((?)±S)and t test if they were consistent with normal distribution.Non-parametric rank sum test is used if it does not conform to normal distribution.P<0.05 was defined as statistically significant.ResultsThere was no significant difference in preoperative clinical data between the microscope group and the laparoscopic group(P>0.05).Three months after operation,the internal diameter of sperocele was significantly improved in 84.6%(22/26 cases)of the microscope group and 61.5%(24/39 cases)of the laparoscopic group,there was a statistical difference between the two groups(χ~2=4.016,P<0.05).Six months after surgery,92.3%(24/26 cases)in the microscope group and 88.0%(22/25 cases)in the laparoscope group,with no significant difference between the two groups(χ~2=0.002,P>0.05).Semen quality:six months after surgery,there were statistical differences between the two groups in semen routine indexes compared with those before surgery(P<0.05).The seminal fluid volume of two group was2.96±1.10 and 3.65±1.16(t=-2.228,P=0.030).Total sperm count was 299.21±303.60 and381.67±228.49(t=-2.020,P=0.043).Postoperative sperm concentration was 101.02±73.43,146.27±71.82(t=-2.291,P=0.022).There was statistical difference between the two groups.PR(%)was 49.39±20.92,50.05±13.37(t=-0.141,P=0.889),PR+NP(%)was 67.66±23.20,68.44±20.34(t=-0.133,P=0.895).There was no statistical difference between the two groups.The recurrence rates of the two groups were 5.1%and 1.1%.Pain improvement accounted for95.2%and 93.8%.The incidence of postoperative complications were 2.2%and 1.1%.The length of hospital stay were 1.00(1.00～2.75)and 1.00(1.00～2.00).There was no statistical difference between the two groups(P>0.05).The pregnancy rates were 43.8%and 10.0%.The cost were 5932.30±1127.40 and 7317.20±1274.40.The operation time was69.50(55.00-88.00)and 39.50(30.00-54.90).There was statistical difference between the two groups(P<0.05).Preoperative testosterone was 13.24(10.95～16.23)nmol/L in patients with varicocele and 15.00(12.33～16.95)nmol/L in patients without varicocele,and there was a statistical difference between them(Z=-3.458,P=0.000).Conclusions1.The diameter of spermatic veins in two groups was effectively improved,and the microscope group is better than the laparoscopic group within 3 months after surgery,but there is no significant difference between the two groups after 6 months after surgery.2.The microscope group had advantages over the laparoscopic group in improving semen volume,total sperm count and sperm concentration,while there was no significant difference in PR(%)and PR+NP(%)between the two methods.3.In terms of natural pregnancy rate,semen quality and cost,the microscope group was superior.Therefore,for patients with infertility,the microscope operation method could be the first choice.However,for the patients who complain of scrotal pain,because the two surgical methods have similar efficacy in relieving pain,such patients can choose the surgical method according to their wishes,cost and whether there are other scrotal diseases.4.Varicocele can lead to lower testosterone levels. |
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