[Varicocele and reproductive function: pathozoospermia treatment (a prospective comparative study)].

Autor:	Bozhedomov VA; Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia.; Polyclinic 3, Presidential Administration, Moscow, Russia., Shomarufov AB; Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia., Bozhedomova GE; Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.; Polyclinic 3, Presidential Administration, Moscow, Russia., D OA; Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia., Kamalov DM; Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia., Sorokin NI; Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia., Kamalov AA; Department of Urology and Andrology, Faculty of Fundamental Medicine, and Head of the Clinic for Mens Health, Lomonosov Moscow State University, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Urologiia (Moscow, Russia : 1999) [Urologiia] 2021 May (2), pp. 62-68.
Abstrakt:	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.
Databáze:	MEDLINE
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