The efficacy of microsurgical varicocelectomy as a salvage option for grade 1 varicocele: a retrospective study

Introduction: Varicocele is an abnormal dilation and tortuosity of the pampiniform venous plexus within the spermatic cord. Although varicocele repair is recommended for male infertile patients with palpable varicocele, it is controversial whether varicocele repair should be performed in patients with low-grade varicocele. This study aimed to evaluate the efficacy of varicocelectomy as a salvage option for patients with grade 1 varicocele. Methods: We retrospectively analyzed data of 38 male infertility patients with grade 1 varicocele who visited the Reproduction Center, Yokohama City University Medical Center, between April 2013 and July 2017 and could be followed up for more than 6 months after treatment. Patients were divided into 2 groups: those treated with an oral antioxidant and traditional herbal medicine alone and those who additionally underwent microsurgical varicocelectomy. Patients’ characteristics and pretreatment and posttreatment semen parameters were compared between the groups using unpaired t and χ2 tests. Results: Twenty-four patients were treated with oral medication alone, and 14 underwent surgery in addition to receiving medication. Six months after the start of treatment, motile sperm concentrations were 4.939±6.257×106/mL and 9.853±16.8×106/mL in the medication and surgery groups, respectively (P=0.26). The amount of change in the motile sperm concentration was significantly higher in the surgery group than in the medication group (−0.94±5.82×106/mL vs. 4.33±5.46×106/mL, P=0.029). Conclusions: Motile sperm concentration significantly improved in patients who additionally underwent surgery. Microsurgical varicocelectomy is an effective salvage option for patients with grade 1 varicocele.