The changes of semen parameters of patients with clinical versus subclinical varicocele managed by laparoscopic varicocelectomy: observational study.

Objectives: To assess the effectiveness of laparoscopic varicocelectomy in patients with clinical versus subclinical varicocele concerning preoperative and postoperative seminal parameters.

Patients and methods: Between February 2021 and August 2024, a total of 162 patients diagnosed with varicocele (72 with subclinical and 90 with clinical presentation) seeking infertility advice (primary or secondary) at the author's institution underwent laparoscopic varicocelectomy and were enrolled in the study. All patients underwent history taking, clinical examination, semen analysis, and scrotal colour Doppler ultrasonography. Patients with recurrent varicocele, azoospermia, or infertility due to causes other than varicocele were excluded from the study. Semen analysis was conducted for all patients before laparoscopic varicocelectomy and 3 to 6 months after varicocelectomy.

Results: Significant improvements in seminal parameters were observed in patients with clinical varicocele (p < 0.05). Bilateral and right-sided varicoceles were more prevalent in patients with subclinical varicocele. Additionally, the incidence of secondary infertility was higher in patients with subclinical varicocele compared to those with clinical varicocele (p<0.05).

Conclusions: Our study indicates favourable outcomes of laparoscopic varicocelectomy in patients with clinical varicocele. Regarding the effects of varicocelectomy in patients with subclinical varicocele, we recommend avoiding varicocelectomy in subclinical group of patients unless no identifiable causes of semen abnormality.