Clinical and laboratory profiles of a large cohort of patients with varicocoele

The prevalence of varicocele is 7% and 10–25% in pre pubertal and post pubertal males, respectively [1]. Varicoceles are found in 21–41% of men with primary infertility and 75–81% of those with secondary infertility. Physical examination of varicocele has a sensitivity and specificity of around 70%. The Color Doppler ultrasound (7MHz) has sensitivity of 50% and specificity of 90%. A pencil probe of 9 MHz is good in detecting subclinical varicocele. This has advantage when bilateral varicoceles are suspected [2].The effect of varicocele on the testis is due to sta-sis of blood, increased testicular temperature, and reflux of toxic metabolites from the kidney and ad-renal gland. This leads to oxidative stress, apoptosis, a deleterious effect on DNA integrity, and the OAT syndrome [3]. The indications for varicocele treatment are pain, arrest of testicular growth, and infertility. Varicoceles in early adolescence should be followed up and treated if there is persistent discrepancy of testicular size by >20% or >2 cm. However, this should be taken in to consideration together with the peak retrograde flow. A peak retrograde flow of 38cm/s or more may indicate that the arrest of tes-ticular growth is likely to worsen [4]. Research by Goldstein's group in 2011 showed that men with var-icoceles have lower testosterone than a comparison group (men without varicoceles presenting for reversal of vasectomy). There was a 70% improvement in testosterone levels of men who had varicocelectomy. The mean increase was 178 ng/dl [5]. Controversies have dominated research on varico-celectomy as a treatment for infertility in the last decade, but research in the last couple of years tends to favor treatment of varicoceles in the presence of abnormal semen parameters and infertility. A prospective randomized trial by Abdel Meguid et al. in which 150 men were randomized to either observation or a microscopic subinguinal varicocelec-tomy revealed an overall improvement in the odds of achieving pregnancy with varicocelectomy. After 12 mos. of follow–up, 13.9% of the observation group and 32.9% of the treatment group had achieved pregnancy (odds ratio [OR]: 3.04; 95% confidence interval [CI], 1.33–6.95). The authors found a number needed to treat of 5.27 (95% CI, 1.55–8.99), which suggests that 5.27 men need to undergo varicocelectomy to achieve one spontaneous pregnancy [6]. A meta–analysis of outcomes of varicocelectomy in the treatment of infertility in oligospermic men in 2011 by Bazeem and coexperts in the field revealed that combined odds ratio was 2.23 (95% …