Introduction: Varicocele is one of the most frequent causes of infertility. There are several therapeutic modalities, namely surgery (open and laparoscopic) and conventional radiology. The aim of our study was to evaluate the impact of a varicocele cure under local anaesthesia on spermogram quality. Material and Methods: We conducted a retrospective descriptive study from 1 January 2022 to 31 December 2023 in the urology department of the H？pital Militaire de Ouakam (HMO). The parameters studied were age, reasons for consultation, time to urology consultation, grade of varicocele, Doppler ultrasound and spermogram data before treatment and 3 months after treatment. Treatment consisted of bilateral subinguinal varicocelectomy under local anaesthetic. Data were entered and analysed using Excel software version 2021. Results: We studied 41 patients. The mean age of the patients was 35.3 ± 6.9 years, with extremes of 22 and 50 years. Thirty-eight of our patients (88.37%) were married. The most frequent reason for consultation was primary infertility (72.09%). 28 patients (68.3%) had a bilateral varicocele on ultrasound. Varicocele was associated with bilateral testicular hypotrophy in 13 patients (31.7%) and unilateral left testicular hypotrophy in 11 patients (26.8%). All patients underwent subinguinal varicocelectomy under local anaesthetic. Mean follow-up was 4.5 months. A clear statistically significant improvement was noted in sperm motility and concentration in postoperative spermograms, with normalisation of the spermogram in 15 (36.5%) of patients. Conclusion: The impact of varicocele on sperm parameters has been clearly established. There are various therapeutic methods for curing varicocele, including varicocelectomy under local anaesthetic, which, in addition to its undeniable economic advantages, can significantly improve sperm parameters in patients with varicocele and prevent their deterioration over time.
References
[1]
Methorst, C., Akakpo, W., Graziana, J.P., Ferretti, L., Yiou, R., Morel-Journel, N., et al. (2021) Recommandations du Comité d’Andrologie et de Médecine Sexuelle de l’AFU concernant la prise en charge de la Varicocèle. Progrès en Urologie, 31, 119-130. https://doi.org/10.1016/j.purol.2020.11.006
[2]
World Health Organization (1992) The Influence of Varicocele on Parameters of Fertility in a Large Group of Men Presenting to Infertility Clinics. Fertility and Sterility, 57, 1289-1293. https://doi.org/10.1016/s0015-0282(16)55089-4
[3]
Benazzouz, M.H., Essatara, Y., Sayegh, H.E., Iken, A., Benslimane, L. and Nouini, Y. (2014) Impact de la varicocèle sur le volume testiculaire et les paramètres spermatiques. Pan African Medical Journal, 19, Article No. 334. https://doi.org/10.11604/pamj.2014.19.334.4693
[4]
Damsgaard, J., Joensen, U.N., Carlsen, E., Erenpreiss, J., Blomberg Jensen, M., Matulevicius, V., et al. (2016) Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels: A Study of 7035 Healthy Young Men from Six European Countries. European Urology, 70, 1019-1029. https://doi.org/10.1016/j.eururo.2016.06.044
[5]
Pagani, R.L., Ohlander, S.J. and Niederberger, C.S. (2019) Microsurgical Varicocele Ligation: Surgical Methodology and Associated Outcomes. Fertility and Sterility, 111, 415-419. https://doi.org/10.1016/j.fertnstert.2019.01.002
[6]
Bagayogo, N.A., Sine, B., Thiam, A., et al. (2021) Varicocele Surgery under Local Anesthesia: Technical Aspects and Feasibility. Annals of African Medicine, 14, e4250.
[7]
Hsu, G., Ling, P., Hsieh, C., Wang, C., Chen, C., Wen, H., et al. (2005) Outpatient Varicocelectomy Performed under Local Anesthesia. Asian Journal of Andrology, 7, 439-444. https://doi.org/10.1111/j.1745-7262.2005.00080.x
[8]
Mbouché, L.O., Mbassi, A.A., Mekeme, J.M., Makon, A.S.N., Fouda, J.C., Ngallé, F.G.E. and Fouda, P.J. (2021) Variations in Spermogram after Varicocelectomy in a Tertiary Hospital in Yaoundé. Revue de Médecine et de Pharmacie, 11, 1223, 1227.
[9]
Bolanga, R.B. (2020) Determinant Parameters of the Spermogram after Varicocelectomy. African Journal of Urology and Andrology, 2, 61-67.
[10]
Sikpa, K.H., Agbedey, M.S., Sewa, E.V., et al. (2023) Varicocele: Epidemiological, Clinical, and Paraclinical Profile in a Sub-Saharan City. ESI Preprints, 23, 705.
[11]
Méndez-Gallart, R., Bautista-Casasnovas, A., Estevez-Martínez, E. and Varela-Cives, R. (2009) Laparoscopic Palomo Varicocele Surgery: Lessons Learned after 10 Years’ Follow up of 156 Consecutive Pediatric Patients. Journal of Pediatric Urology, 5, 126-131. https://doi.org/10.1016/j.jpurol.2008.10.009
[12]
Galfano, A., Novara, G., Iafrate, M., Fracalanza, S., Novella, G., Cavalleri, S., et al. (2008) Surgical Outcomes after Modified Antegrade Scrotal Sclerotherapy: A Prospective Analysis of 700 Consecutive Patients with Idiopathic Varicocele. Journal of Urology, 179, 1933-1937. https://doi.org/10.1016/j.juro.2008.01.042
[13]
Ngalle, F.E., Mbouche, L., Mpah, E.M., Mekeme, J.M., Essomba, A., Nkolo, D.E., et al. (2023) Clinical and Morphological Profile of Male Infertility in 3 Reference Hospitals in the City of Douala in Cameroon. African Urology, 3, 77-81. https://doi.org/10.36303/auj.0072
[14]
Belczak, S.Q., Stefaniak, V., Góes, L.G., Coelho Neto, F., Araújo, W.J.B.d. and Silva, N.A.C.d. (2021) Improvement of Semen Parameters after Coil Embolization of Varicoceles: A Systematic Review. Journal Vascular Brasileiro, 20, e20200137. https://doi.org/10.1590/1677-5449.200137
[15]
Benazzouz, M.H., Essatara, Y., Sayegh, H.E., Iken, A., Benslimane, L. and Nouini, Y. (2014) Impact de la varicocèle sur le volume testiculaire et les paramètres spermatiques. Pan African Medical Journal, 19, Article No. 334. https://doi.org/10.11604/pamj.2014.19.334.4693
[16]
Fouda, J., Mekeme, J.M., Owon’abessolo, P., Mbassi, A., Mbouche, L., Makon, A.N., et al. (2023) Study of Spermogram and Sex Hormones before and after Cure of Subinguinal Varicocele in Infertile Patients. African Urology, 3, 28a-28d. https://doi.org/10.36303/auj.0046
[17]
Diallo, A.B., Bah, I., Barry, M., Diallo, T.M.O., Bah, M.D., Kanté, D., et al. (2015) La varicocèle de l’adulte: Aspects anatomo-cliniques et resultats therapeutiques au service d’urologie-andrologie du CHU de Conakry, Guinee. African Journal of Urology, 21, 137-141. https://doi.org/10.1016/j.afju.2015.02.002
[18]
Diao, B., Faye, O., Fall, P.A., Diallo, A.S., Ndoye, A.K. and Afoutou, J.M. (2006) Profil spermiologique de l’époux dans les couples infertiles en milieu négro-africain au Sénégal. Andrologie, 16, 247-252. https://doi.org/10.1007/bf03034863
[19]
Fall, B., Diao, B., Sow, Y., Sarr, A., Fall, P.A., Ndoye, A.K., et al. (2010) Impact de la varicocélectomie chez les patients ayant une azoospermie non obstructive ou une oligozoospermie sévère. Basic and Clinical Andrology, 20, 257-261. https://doi.org/10.1007/s12610-010-0101-4
[20]
Pasqualotto, F.F., Sobreiro, B.P., Hallak, J., Pasqualotto, E.B. and Lucon, A.M. (2006) Induction of Spermatogenesis in Azoospermic Men after Varicocelectomy Repair: An Update. Fertility and Sterility, 85, 635-639. https://doi.org/10.1016/j.fertnstert.2005.08.043
