Presentation Authors: Gunter De Win, Edegem, Belgium, Eline Coeck*, Sarah Stuer, Wilrijk, Belgium, Stefan De Wachter, Diane De Neubourg, Usha Punjabi, Edegem, Belgium
Introduction: The correct indication for varicocele repair in adolescents remains a subject of ongoing debate. There is a growing interest in selecting adolescent patients based on Peak Retrograde Flow (PRF) measurements as a high PRF (> 38 cm/s) seems to have an impact on testicular growth. The main objective of this study was to analyze the effect of PRF on semen quality, including sperm DNA integrity
Methods: This was a prospective, cross-sectional, observational study. Between February 2017 and January 2018, eighty four volunteers (mean age 21.5 years) were recruited and 78 met the inclusion criteria. Every participant had a scrotal ultrasound to calculate testicular volumes (using the Lambert formula) and TAI. If varicocele was present, the grade and PRF in supine position was measured. All participants provided a semen sample. Standard semen parameters were analyzed according to the WHO 2010 guidelines, and sperm DNA-fragmentation test was performed using TUNEL assay in both total and vital fractions of the semen.
Results: Participants were divided into 3 groups: a control group (n=47; 60.3%) without varicocele, a group with varicocele and a PRF < 38 cm/sec (n=24; 30.8%) and a group with varicocele and a PRF â‰¥ 38 cm/sec (n=7; 9.0%). Sperm concentration and morphology were not significantly different in the healthy control and in the varicocele group with high/low PRF. Progressive (p = 0.006) and total sperm motility (p = 0.006) was significantly lower in varicocele patients with a high PRF, compared to the control group and varicocele patients with a low PRF. Total sperm DNA fragmentation (sDF) was significantly higher in varicocele patients with high PRF compared to the controls (p = 0.006). While no significant difference was observed between controls and varicocele patients with low PRF. Vital sDF was significantly lower in varicocele patients with low PRF compared to varicocele patients with high PRF (p = 0.009).
Conclusions: Increased PRF may negatively affect spermatogenesis via sperm motility and sperm DNA integrity both in the total and the vital fractions of the semen. In adolescents with a varicocele, a PRF higher than 38 cm/s may be an indicator of progressive disease and may help clinicians decide on surgery.