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AI InsightVarikoseli olan olgularda seks hormonlarının değerlendirilmesine gerek olmadığı ve cerrahi tedavide mikrocerrahi yöntemin tercih edilmesi gerektiği kanısındayız.
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Özet
Mikrocerrahi varikoselektomi son yıllarda yaygın olarak uygulanmaktadır. Biz bu çalışmada inguinal varikoselektomi ve subinguinal mikrocerrahi varikoselektomi tekniklerinin, semen ve hormon parametrelerine etkilerini karşılaştırarak etkinliğini değerlendirdik. Kliniğimize infertilite nedeniyle başvuran, semen parametrelerinde bozukluğu olan, tek taraflı varikosel saptanan 56 hasta çalışmaya dahil edildi. Tüm olguların ameliyat öncesi ve sonrası (3., 6., 12. aylarda) semen ve hormon analizleri yapıldı. Birinci gruptaki 30 hastaya inguinal varikoselektomi, ikinci gruptaki 26 hastaya ise subinguinal mikrocerrahi varikoselektomi uygulandı. Olguların ameliyat öncesi ve sonrası semen parametreleri, hormon düzeylerine bakıldı ve komplikasyonları karşılaştırılarak değerlendirildi. Çalışmamızda birinci gruptaki olguların yaş ortalaması 29,5±4,2, operasyon süresi 24±4,5 dakikaydı. İkinci gruptaki olguların yaş ortalaması 28±5,4 operasyon süresi 38±6,4 dakikaydı ve mikrocerrahi grubunda operasyon süresinin anlamlı olarak uzun olduğu görüldü (p<0,05). Birinci yılın sonunda her iki gruptaki motilite değerinde istatistiksel anlamlı artış bulundu (p<0,05). Grupları karşılaştırdığımızda ise mikrocerrahi uyguladığımız grupta motilite artışı anlamlı olarak daha yüksekti (p<0,05). FSH, LH, PRL, E2, Total testosteron ve Serbest testosteron düzeylerinde, her iki grup içinde ve gruplar arasında hem ameliyat öncesi değerler hem de ameliyat sonrası değerlerde anlamlı farklılık yoktu. Varikoseli olan olgularda seks hormonlarının değerlendirilmesine gerek olmadığı ve cerrahi tedavide mikrocerrahi yöntemin tercih edilmesi gerektiği kanısındayız.
Abstract
Introduction: Treatment of varicocele can provide improvement in sperm parameters, although its effect on fertility is not clear. Microsurgical varicoselectomy, one of the surgical treatment options of the varicocele, is widely used nowadays. In this study we compare the effects of subinguinal microsurgery and inguinal varicoselectomy on sperm and hormone parameters. Materials and Methods: Between 2001 and 2003, 56 patients who visited our clinic because of infertility enrolled to our clinic study. All patients were infertile men who were married, could not have a spontaneous baby at least in one year and had abnormality in sperm parameters and unilateral varicocele. All the patients had preoperative and postoperative (3rd, 6th, 12th months) sperm and hormone analysis. Colored Doppler ultrasound examination was performed preoperative and postoperative month 12. Sperm samples were evaluated considering WHO (World Health Organization) and Kruger strict criterions. FSH, LH, PRL, E2, Total testosterone and free testosterone were studied as hormone parameters. Inguinal varicoselectomy was performed to 30 patients in group 1 and subinguinal varicoselectomy was performed to 26 patients in group 2. Preoperative and postoperative sperm parameters and hormone levels of the patients were examined and compared considering the complications of the two methods. Results: The mean age of the patients in fist group was 29.5±4.2 and the mean operation time was 24±4.5 minutes. The mean age of the patients in second group was 28±5.4 and the mean operation time was 38±6.4 minutes. The operation time was longer in microsurgery group which was meaningful (p<0.05). At the first year evaluation of the patients in group 1, there was a significant increase in mean sperm motility (p<0.05). 13 (46.4%) patients had significant improvement in motility, 5 (17.8%) in sperm quantity and 4 (14.3%) in morphology while assessing patients who have improvement in sperm parameters. Also there was significant improvement in mean motility in group II (p<0.05). In group 2, among the patients which has significant improvement in their sperm parameters, 15 (60%) had recovery in motility, 4 (16%) in sperm quantity, 4 (16%) in morphology. There were no meaningful statistical difference between two groups considering preparative and postoperative FSH, LH, PRL, E2, total testosterone and free testosterone hormone levels. Conclusion: In microsurgery group increase in sperm motility was higher and complication rate was lower comparing to the other group. Microsurgery varicoselectomy is a minimal invasive technique which has high success and low recurrence and complication rate. We think that there is no need for investigating sex hormone levels in men with varicocele and microsurgery should be the preferable method in treatment.