THE IMPACT OF LOUPE-ASSISTED INGUINAL VARICOCELECTOMY ON SEMEN QUALITY AND PREGNANCY RATE

Context

Open varicocelectomy is generally performed without microscopic equipment in Iran. We report our experience with loupe-assisted inguinal varicocelectomy, and its impact on semen parameters and pregnancy rate.

Subjects and Methods

We conducted a retrospective interventional study on secondary data obtained from the medical records of 303 men with varicoceles, who underwent an inguinal varicocelectomy between March 2003 and April 2012. The surgical technique involved the use of a 3.0 × loupe during spermatic cord dissection at the level of the internal inguinal ring under spinal anesthesia. Semen samples were analyzed for sperm concentration, motility, and sperm morphology before the varicocelectomy and after 3 months. All the infertile patients were followed-up postoperatively for more than 1 year.

Results

There were 9 (3.0%) varicocele recurrences and 3 (1.0%) hydroceles. After varicocelectomy, sperm concentration and motile spermatozoa increased. In addition, spermatozoa with normal morphology improved significantly postoperatively. Of the 303 subjects treated, 153 (83.2) had a 1-year preoperative history of infertility; the spontaneous pregnancy rate of the spouses during the follow-up period was reported to be 61.4%.

Conclusions

The results of this research indicated that varicocelectomy using loupe-assisted inguinal technique could improve semen parameters and pregnancy rate with a low postoperative complication rate.

Color Doppler findings of post-biopsy arteriovenous fistula in renal transplant

Post biopsy arterio-venous fistula in renal transplant range in incidence from 15-16%. Spontaneous resolution of 75% A-V fistulas is seen within four weeks. We report a patient with post biopsy arterio-venous fistula who had developed unexplained hypertension with no definite feature of rejection on biopsy. Doppler application revealed an arterio-venous fistula which showed spontaneous resolution in six weeks.