Varicocelectomy for Nonobstructive Azoospermia Should Be Considered Only in Carefully Selected Patients: Opinions Based on Treatment Experience at Dokkyo Medical University.

INTRODUCTION:The need for varicocelectomy for varicoceles complicated by nonobstructive azoospermia (NOA) has long been debated in the field of male infertility. In this study, we analyzed the clinical outcomes of varicocelectomies for varicoceles in patients with NOA. METHODS:We retrospectively reviewed the following data of 11 patients with NOA and varicoceles who underwent varicocelectomies: age at admission, right and left testicular volumes, operative varicocele grades, operative site, body mass index, endocrine and genetic examination results, number of semen analyses before and after varicocelectomy, sperm appearance rate in ejaculated semen after varicocelectomy, sperm retrieval rate (SRR) with microdissection testicular sperm extraction (MD-TESE), and histopathological analysis results of testicular tissue. RESULTS:Varicocelectomies were performed bilaterally and on the left side in 1 and 10 patients, respectively. The number of pre- and postoperative semen analyses was 1-3 and 1-7, respectively. Ejaculated semen analysis after varicocelectomy did not reveal sperm in any patient. Ten patients underwent MD-TESE; however, sperm was retrieved from only two patients (20%). Pathological examination of seminiferous tubular tissue collected by MD-TESE revealed hyalinization in one patient, Sertoli cells in eight, and hypospermatogenesis in two. CONCLUSIONS:Sperm could not be retrieved from the ejaculated semen of patients with NOA and varicoceles who underwent varicocelectomies, and the SRR of MD-TESE was suboptimal. These results suggest that varicocelectomy should be performed cautiously in patients with NOA.