FINE-NEEDLE ASPIRATION TESTICULAR CAN CHANGE THE STRATEGY OF SURGICAL VARICOCELE?

Objective

The varicocele is considered the most common cause of male infertility, but the underlying mechanisms of altered spermatogenesis are still controversial. In particular, it is not a clear distinction between dyspermia "due to varicocele" and dyspermia "with varicocele," which is the key decision for the correction of this disease and the cause of much controversy over the impact of varicocele related male infertility. A morphological study by preoperative fine-needle aspiration of testicular tubular injury provides valuable information on the diagnosis and its use is a predictive parameter for successful treatment. Our goal is to see if indeed the testicular fine needle aspiration can really change the therapeutic strategy of varicocele.

Methods and results

In this retrospective study we evaluated 1185 patients operated on for primary infertility of left varicocele from January 2002 to March 2011. All patients were subjected to history, physical examination, at least 2 examinations of seminal fluid , bacteriological tests , hormonal profile (FSH, LH, PRL, Total Testosteron) and Doppler ultrasound with testicular volume. We excluded patients with other potential causes of dyspermia ( inflammatory , endocrine , congenital anomalies). In all patients was performed , at the time of surgical treatment , testicular fine needle aspiration sec. Foresta; informed consent was obtained for additional invasive procedure . FNA samples were assessed by a single cytologist particularly expert in testicular morphology . We repeated clinical examination and semen analysis on the third and sixth month after surgery. The improvement of the parameters of number , motility and morphology was assessed by analysis of covariance and mixed linear regression .
Based on the seminal parameters observed at six months post-operatively , patients were reclassified into three groups:
Group A ( 62.8 %, ) = significant improvements (p 0.05 )
Group C (21.2%) = stable or worsened ( p> 0.05)
For each group we have identified the cytological pattern .
Group A: cytology was normal in 35.4 % . In the remaining resulted prevailing framework of mild hypospermatogenesis ( 50.6 % ) or slightly impaired spermatogenesis ( 14 % ) .
Group B: testicular morphology was normal in 15% . A framework of hypospermatogenesis mild / medium was found in 18.9 % of cases, and severe hypospermatogenesis or spermatidic arrest in 56.4 % . In 9.7 % was seen a picture of early maturation arrest or partial Sertoli -only.
Group C: normal testicular morphology was found in 0% of cases. More specifically : in 7% of cases severe hypospermatogenesis , early maturation arrest 87.4 % , in 5.6 % of cases there was a partial Sertoli -only.

Discussion

The high incidence of controversial in the treatment of male infertility, impose a practical and critical specific sensitivity in the care and clinical management. From the results obtained from the study it is evident the strong prognostic value of testicular needle aspiration in patients with clinical varicocele. The analysis of testicular structure by fine-needle aspiration cytology seems to have high negative predictive value of the finding of early maturation arrest or partial Sertoli-only for the surgical correction of varicocele. In light of these results, then we need proper preoperative counseling in patients with clinical varicocele who exhibit early maturation arrest or partial Sertoli-only. The positive role of this therapeutic strategy should be further validated by randomized trials.