VARICOCELE AND REPRODUCTIVE FUNCTION: PATHOZOOSPERMIA TREATMENT (A PROSPECTIVE COMPARATIVE STUDY)


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Abstract

Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. Objective: to evaluate the standardized effect (Es) of nutrient therapy, microsurgical and laparoscopic varicocelectomy for pathozoospermia. Study design: a multicenter case-control study with stratified randomization. Materials and methods: data of a clinical and laboratory examination of patients with clinical varicocele over a 3-month period in the groups: A) the observation/control group (n=33), B) the group treated with nutrients (n=63), C) the group of patients after microsurgical varicocelectomy with a subinguinal mini access (n=86), D) the group of patients following laparoscopic surgery (n=36). The ejaculate was evaluated according to WHO-2010, DNA fragmentation by chromatin dispersion in an agarose gel. Results. After 3 months, varicocelectomy leads to an increase in sperm concentration and motility: the median of the total number of progressively motile spermatozoa in the ejaculate in A is +0.4 million; B - +1.9 million; C - +17.1 million (p<0.05); D - +21.2 million (p<0.05). A clinically significant increase in this indicator after varicocelectomy was found in 2/3 of cases: 65% (B; p<0.05) and 67% (G; p<0.05) with 38% (A) and 42% (B). Varicocelectomy leads to a decrease in sperm DNA fragmentation by an average of 5.5% (p<0.05) with an improvement in 59% of patients, but a 3-month therapy with nutrients reduces DNA fragmentation in a similar way: 5.5% (p<0.05), 66% of improvement cases. The differences in effect between B and D are insignificant (p> 0.05). The laparoscopic surgery demonstrated higher Es than microsurgical operation (Es=0.70 and 0.44, with 0.29 in the patient receiving nutrients and 0.22 in the patients in the control group) Conclusion Varicocelectomy significantly improves sperm quality in 2/3 of cases, including 5.5% decrease in DNA fragmentation. Nutrient therapy produces similar DNA fragmentation improvement. Further research is necessary to identify who really requires varicocelectomy and who does not.

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About the authors

V. A Bozhedomov

Lomonosov Moscow State University; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology; Polyclinic №3, Presidential Administration

Email: vbojedomov@mail.ru
Doctor of Medical Sciences, Professor, Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Men’s Health, Lomonosov Moscow State University; Leading Researcher at Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia Moscow, Russia

A. B Shomarufov

Lomonosov Moscow State University

Email: doctor.shomarufov@gmail.com
urologist, Ph.D. student at the Department of Urology and Andrology, Faculty of Fundamental Medicine Moscow, Russia

G. E Bozhedomova

Lomonosov Moscow State University; Polyclinic №3, Presidential Administration

Email: bozhiedomova@bk.ru
medical technologist at clinic “Men’s health” of Medical Research and Educational Center of Moscow State University by Lomonosov and Department of Obstetrics and Gynecology of Polyclinic №3, Presidential Administration Moscow, Russia

D. A Ohobotov

Lomonosov Moscow State University

Email: 14072003m@gmail.com
Ph.D., urologist at the Medical Research and Educational Center, senior tutor of the Department of Urology and Andrology, Faculty of Fundamental Medicine Moscow, Russia

D. M Kamalov

Lomonosov Moscow State University

Email: davidffm@mail.ru
Ph.D., urologist at the Medical Research and Educational Center Moscow, Russia

N. I Sorokin

Lomonosov Moscow State University

Email: nisorokin@mail.ru
Ph.D., MD, professor, Chief of Urologic Department of Medical Research and Educational Center, leading researcher of the Department of Urology and Andrology, Faculty of Fundamental Medicine Moscow, Russia

A. A Kamalov

Lomonosov Moscow State University

Email: priemnaya@mc.msu.ru
Academician of the RAS, Ph.D., MD, professor, Head of the Department of Urology and Andrology, Faculty of Fundamental Medicine, Director of the "University Hospital" Moscow, Russia

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