CODE: 14 - Comparative assessment of laparoscopic varicocelectomy in smoking and no smoking 367 subfertile men
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Jacek Huk, Mieczysław Fryczkowski, Andrzej Kupilas, Zbigniew Kaletka

Katedra i Klinika Urologii w Zabrzu Śląskiej Akademii Medycznej w Katowicach

summary

Introduction. The aim of the paper is to assess results of laparoscopic treatment of varicocele in subfertile men.

Materials and methods. In the years 1995-2004 transperitoneal laparoscopic vericocelectomy was performed in 367 men with unilateral varicoceles: 253 (68.9%) non smokers (Gr. I) and 114 (31.1%) smokers (Gr. II). The treatment efficacy was comparatively evaluated in Gr. I and Gr. II and also in two age groups: A - 18-30 years old (216-58.9%) men, B - 31-40 years old (151-41.1%) men. Pre- and postoperative evaluation was based on andrological, sonographic (collor Doppler ultrasound) and semen examination.

Results. Before and during the 9th month after the laparoscopic operation in both groups the average sperm count (x 106/ml) were respectively: Gr. I: 19.67 ?9.26 and 38.82 ?11.52, Gr. II: 18.91 ?11.26 and 27.62 ?11.20 (p<0,001). The average rate of motility (%) was respectively: Gr. I: 18.94 ?10.26 and 40.83 ?14.62, Gr. II: 20.64 ?8,09 and 26.82 ?9.61 (p<0,007). The average rate of normal forms (%) was respectively: Gr. I: 22.10 ?9.56 and 55.12 ?24.52, Gr. II: 22.10 ?9.56 and 42.12 ?16.23 (p<0,001). Pregnancy rate was in Gr. I - 30.8% in 78 couples, Gr. II - 16.7% in 19 couples (p<0,001). In age groups before and after operation were respectively: the average sperm count (x 106/ml) Gr.A - 20.21 ?14.42 and 41.12 ?20.34, Gr. B - 18.62 ?9.14 and 32.74 ?7.16 (p<0,001). The average rate motility (%) was respectively: Gr. A - 21.91 ?11.86 and 43.51 ?12.21, Gr. B - 19.64 ?16.26 and 28.12 ?16.11 (p<0,005). The average rate of normal forms (%) was respectively: Gr. A - 22.89 ?6.91 and 55.78 ?21.32, Gr. B - 20.92 ?8.78 and 49.16 ?12.62 (p<0,007). Pregnancy rate was 32.4% - in 70 couples (Gr. A) and 17.9% in 27 couples (Gr. B) (p<0,005).

Conclusions. Laparoscopic corrective surgery of varicocele in no smoking, subfertile men enables to obtain significantly higher improvement of sperm density, percentage of progressive motile sperm, properly formed sperm as well as twice much percentage of pregnanacies among infertile couples in comparison to varicocelectomy in smoking, subfertile men. Laparoscopic varicocelectomy regardless of tabaco smoking allows to obtain significantly higher improvement of sperm qualities as well as percentage of pregnancies in the group of marriages in which men did not reach 30 years of age.