Akash M Patel MD, Presenter: Nothing to Disclose

Dharti Patel DMRD, Abstract Co-Author: Nothing to Disclose

Subhash Kumar MBBS, Abstract Co-Author: Nothing to Disclose

Digish Vaghela MD, Abstract Co-Author: Nothing to Disclose

Tejal Patel, Abstract Co-Author: Nothing to Disclose

Darshan Patel MBBS, Abstract Co-Author: Nothing to Disclose

Hasmukh Jagdishbhai Prajapati MBBS, Abstract Co-Author: Nothing to Disclose

Bhavesh Talsaniya MBBS, Abstract Co-Author: Nothing to Disclose

Urvil Shah, Abstract Co-Author: Nothing to Disclose

Pankaj Amin MD, Abstract Co-Author: Nothing to Disclose

Hitesh Rajpura MD, Abstract Co-Author: Nothing to Disclose

Jayesh Patel, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Review significance of varicocele grading which can help to predict postsurgery outcome by evaluating effect of severity of primary varicocele on spermatogenesis as judged by improvement in semen profile after surgery.

385 infertile male patients with primary varicocele were studied. 283 were left sided and 80 bilateral.All patients had semen counts between 5-20 million/cmm.Patients with secondary varicocoele and other causes producing infertility and affecting semen quality were not includedFour grades of varicocele were identified – Grade 0 - subclinical i.e. found only on Doppler, Grade 1- palpable on Valsalva, Grade 2 – palpable at rest, Grade 3 - seen at rest. Patient distribution –Gr 0 : 113, Gr 1 : 55, Gr 2 : 135, Gr 3 : 82.Half the patients underwent surgery through transinguinal approach.. Improvement was considered when sperm count exceeded 20 million / cmm, normal spermatocytes above 60%, mature spermatocytes above 97% and motility above 60% at one year.

In conservatively treated patients, in Gr 0, 13 of 57 improved, 10 worsened, rest remained unchanged, in Gr 1, 16 of 28 unchanged, 9 worsened, 3 improved , in Gr 2, 22 of 68 worsened, 3 improved, rest unchanged, in Gr 3,19 of 41worsened, one improved, rest unchanged. In surgically treated patients, in Gr 0, 19 of 56 improved, 3 worsened, rest unchanged, in Gr 1, 15 of 27 unchanged, 8 improved, 4 worsened, in Gr 2, 15 of 67 improved, 11 worsened, rest unchanged, in Gr 3, 11 of 41improved, 7 worsened, rest unchanged. Of 80 bilateral varicocoeles, at least one side was at least of Gr 2 or above in most cases. 34 patients underwent surgery on both sides out of which 17 showed improvements while 13 remained static and 4 worsened. 46 did not undergo surgery of which 20 worsened, 2 improved while rest remained static.

Grading of varicocele is helpful in predicting postsurgical prognosis. Grades 2 and 3 varicoceles have better postsurgical improvement than have grades 0 and 1 while patients with bilateral varicoceles are excellent beneficiaries.

As varicocele is associated with infertility, its grading will help in choosing and counseling patients who will benefit most from surgery.

Patel, A, Patel, D, Kumar, S, Vaghela, D, Patel, T, Patel, D, Prajapati, H, Talsaniya, B, Shah, U, Amin, P, Rajpura, H, Patel, J, et al, , Grading of Varicocele versus Postsurgical Outcome.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4438267.html