What is the role of pre-operative blood parameters in forecasting varicocelectomy success?

The effect of systemic inflammatory index and systemic inflammatory response index on success of varicoselectomy

BACKGROUND

Varicocele is the most common correctable cause of male infertility. The treatment of varicocele is surgery. However, which patients will benefit from the surgery is controversial. Our aims to investigate the effect of systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) on varicocelectomy success.

METHODS

Patients who underwent varicocelectomy in our clinic between January 2016 and June 2022 were analyzed retrospectively. Varicocelectomy success was defined as >50% increase in post-operative total motile sperm count (TMSC) in those with pre- operative TMSC > 5 million and at least 100% increase in those with <5 million. The patients were divided into two groups as benefiting from the treatment (Group 1) and no benefits (Group 2).

RESULTS

Of the 207 patients who underwent varicocelectomy, 144 (69.6%) of them improved their semen parameters, and 63 (30.4%) did not. The optimum cut-off value of SII was 334.6, with an AUC of 0.733 (95% CI: 0.665-0.813). The best cut-off value for SIRI of 0.882, with an AUC of 0.692 (95% CI: 0.607-0.772). The highest sensitivity and specificity were 0.692 and 0.601 (p < 0.001). In the multivariate analysis, only SII (OR: 3.152, 95% CI: 1.316-7.358; p = 0.003) and SIRI (OR: 2.919, 95% CI: 1.472-5.774; p = 0.002) were independent predictive factors for varicocelectomy success.

CONCLUSIONS

Our results showed that preoperative SII and SIRI values were lower in infertile patients who underwent successful varicocelectomy. Therefore, we think that these parameters will be useful in identifying patients who will benefit before varicocelectomy.

Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

PURPOSE

The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles.

MATERIALS AND METHODS

The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies).

RESULTS

Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129-0.278; p<0.001; I²=83.62%, Egger's p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474-1.706; p<0.001; I²=97.86%, Egger's p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526-2.121; p<0.001; I²=97.88%, Egger's p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318-1.968; p<0.001; I²=98.65%, Egger's p=0.0003; progressive sperm motility: SMD 1.845, 95% CI: 1.537%-2.153%; p<0.001; I²=98.97%, Egger's p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%-1.759%; p<0.001; l2=97.98%, Egger's p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%-1.211%; p<0.001; I²=97.87%, Egger's p=0.1864.

CONCLUSIONS

The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele.

Can preoperative inflammatory markers predict the success of varicocelectomy?

The aim of this study was to evaluate the effect of inflammation on the success of varicocelectomy by using some inflammatory markers. Adult male patients aged ≥18 years who were evaluated for infertility, had abnormal parameters in at least two preoperative semen analyses and underwent subinguinal microscopic varicocelectomy were retrospectively evaluated. The patients were divided into two groups; those showing improvement in semen parameters were determined as Group A and those without improvement as Group B and compared with each other. A total of 102 patients were included in this study. Group A contained 32 (31.4%) patients while Group B had 70 (68.6%) patients. Monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) were found to be statistically significantly higher in Group B (p = 0.014 and p = 0.028 respectively). Although preoperative sperm concentration and total motile sperm count were higher in Group B, postoperative all semen parameters were significantly higher in Group A. The cutoff points that were determined using the Youden test were <2.02 for NLR (AUC = 0.636, CI = 0.519-0.754; p = 0.028) and <0.22 for MLR (AUC = 0.652, CI = 0.531-0.773; p = 0.014). Pre-varicocelectomy low NLR and MLR values were found to be significant parameters in predicting the success of the surgery.