A Cohort Study:the Influence Of Three Different Spermatic Vein Ligation Operations On Sperm Motility

IntroductionVaricocele refers to the abnormal growth,expansion,and varicosity of the venous plexus of the spermatic cord.To Varying degrees,patients with varicocele often complicate with lower semen quality,mostly with reduced sperm counts,decreased sperm motility,and increased numbers of immature and pointed sperm.Some Severe cases may manifest as azoospermia.Research purposesThe purpose of this study is to compare the improvement of sperm motility of patients,who had varicocele and asthenospermia and were treated respectively with three different surgical techniques:open retroperitoneal high ligation,laparoscopic varicocelectomy and subinguinal microscopic ligation.Research MethodsThis prospective cohort study started on October 15,2015,and ended on December 31,2016.Follow-up was divided into two period:within 3 months and from 3 months to one year.Patients enrolled in the cohort were required to meet the following criteria simultaneously:1 Clinically diagnosed as varicocele,with ultrasound confirmed the diameter of spermatic vein caliber was more than 0.2 cm;2 Semen quality examination suggested asthenospermia:a.Percentage of forward sperm(PR)<32%;b.percentage of total sperm motility(PR+NP)<40%;c.number of forward motile sperm(PMOTS)<20M.Meanwhile,exclusion criteria including:1 Clinically and ultrasound dignosed as varicocele,but preoperative semen quality examination denied asthenospermia;2 combined with proximal and distal jaws phenomenon or secondary varicocele;3 combined with other urogenital diseases which may affect sperm motility.The research indicators include:varicocele indexing,ultrasound measurement of spermatic vein caliber,sperm motility before and after surgery(such as the percentage of the forward sperm,the total sperm motility,the number of forward sperm,etc.),operation duration,hospitalization stay and expenses,postoperative varicocele recurrence and other complications.A total of 72 patients were enrolled according to the inclusion criteria.Among them,37 patients underwent open retroperitoneal high ligation,18 underwent laparoscopic varicocelectomy,and 17 accepted subinguinal microscopic ligation.Conclusion:Through the comparison of varicocele patients underwent three different surgical techniques,we found:1.All three kinds of varicocele ligation significantly improved the quality of semen in patients.2.About the complications rate,2 cases occurred hydrocele postoperatively,with 1 of them accepted traditional varicocele ligation and 1 underwent microscopic varicocele ligation.In addition,one patient developed acute epididymitis after the procedure.Totally 5 patients experienced recurrence of varicocele during follow-up.Among them,3 patients received conventional,2 patients underwent laparoscopic.There was no statistically significant difference between groups.3.Undergoing microscopic varicocele takes longer than the other two(P<0.05).Laparoscopy needs more hospitalization expenses(P<0.05).