IMPACTO DE LA

VARICOCELECTOMA BILATERAL EN
EL ANLISIS DE SEMEN Y SU
EFECTO EN LA FERTILIDAD

DR. JUAN CARLOS CASTAEDA

CONCURSO M.S.D.

INTRODUCCIN
Varicocele prevalencia: 15 al 20 %.
40% tiene relacin con infertilidad.
Manifestaciones en ANASEM:
Oligozoospermia
Astenozoospermia
Teratozoospermia
24. Fretz PC, Sandlow JI. Varicocele: ideas actuales sobre su fisiopatologa, diagnstico y tratamiento. Clin
Urol Norteam 2002:931-47.

INTRODUCCIN
Aumento de la temperatura de 0.8 a 1
C.

Tasa de embarazo post varicocelectoma:

36-50%
14. Turner RR. Varicocele: still an enigma. J Urol 2000;129(4):695-9

INTRODUCCIN
TCNICA

Preserv Hidrocel
a
e (%)
Arteria

Falla
(%)

Potencial de
morbilidad
seria

No

Retroperitone
al

No

Inguinal
convencional

No

3-30

1525
5-15

Laparoscopica

Embolizacin
Inguinal
microquirrgic
a

S
S

12
0
0

5-15
150.5
25

S
S
No

Subinguinal

0.8

<1

No

23.

No

Sigman M, Howards SS. Male infertility. In: Walsh PC, Retik AB, Vaughn ED, Wein AJ, editors. Campbells
urology. 8th edition. Philadelphia: WB Saunders; 2002. p. 1287-330.

OBJETIVO

Determinar si existe mejora de los

parmetros
seminales
en
los
pacientes
postoperados
de
varicocelectoma
bilateral
con
tcnica subinguinal macroquirrgica
y el impacto en la fertilidad.

MATERIALES Y MTODOS
Diseo del estudio:
Estudio de cohorte prospectiva
Longitudinal
Comparativo
Observacional.

MATERIALES Y MTODOS
Pacientes con varicocele bilateral e infertilidad en
el servicio de androloga de abril 1998 a septiembre
2003.

Diagnstico clnico y por USG escrotal con

maniobra de valsalva.

Anlisis de semen (OMS y Kruger) preQx y 3, 6 y

12 meses postQx.

MATERIALES Y MTODOS
Criterios de exclusin:
Factor
femenino
positivo
para
infertilidad.
Varicocelectoma por otra causa distinta
a
infertilidad.
Tcnica diferente a Marmar.
Tratamiento hormonal y/o antioxidantes.
Expedientes depurados o incompletos.

MATERIALES Y MTODOS

NORMAL

LEVE

MODEREADA

SEVERA

CONCENTRACION
(mill./ml.)

>20

10-20

5-9

<5

MOVILIDAD
(%)

A+B>50
(A>25)

A+B
40-50

A+B
20-39

A+B
<20

O.M.S.

MATERIALES Y MTODOS
Motilidad a: Progresiva
rpida.
(>25microm/s)
Motilidad b: Progresiva
lenta.
(524microm/s)
Motilidad c: No progresiva.
(<5microm/s)
Motilidad d: Inmviles

MATERIALES Y MTODOS

Morfologa:
Criterios de Kruger >14%.

MATERIALES Y MTODOS

MATERIALES Y MTODOS
Varicocelectoma bilateral con tcnica de Marmar.

MATERIALES Y MTODOS

Se aplic la de prueba de Friedman y

Wilcoxon para concentracin y motilidad
espermtica y para morfologa la prueba
de Cochran y McNemar, considerando
significativo un valor de p < 0.05.

RESULTADOS
De abril 1998 a septiembre 2003 se
realizaron
184 varicocelectomas

bilateral.

24

pacientes

130 bilaterales
con

varicocele

RESULTADOS
Edad promedio 31 aos (20-47 aos).

Aos de infertilidad promedio 3.5 aos (112 aos).

TIPO DE ALTERACIONES MORFOLGICAS

ALTERACIN MORFOLGICA

% PROMEDIO

DS

Cola

27.25

14.45

Amorfo

25.92

16.85

Acintados

17

11.43

Piriforme

9.42

8.84

Alfiler

2.58

3.44

Microcfalo

2.46

2.99

Dobles

1.29

1.60

Gota citoplasmtica

1.12

1.29

Macrocfalo

0.29

0.62

ALTERACIONES EN EL ANLISIS DE
SEMEN

OLIGOZOOSPERMIA

ASTENOZOOSPERMIA

TERATOZOOSPERMIA

ANLISIS ESTADSTICO

Wilcoxon
Wilcoxon
McNemar

p=NS
p=0.004
p=0.016

p=0.011
p=0.002
p=0.004

p=0.000
p=0.000
p=0.000

EMBARAZOS

RESULTADOS

No se documento recurrencia del

varicocele en seguimiento hasta la
fecha.

CONCLUSIONES
La varicocelectoma bilateral con tcnica de
Marmar, es reproducible, con mnima
morbilidad y efectiva al incrementar
progresivamente la concentracin, movilidad
y morfologa espermtica.
La
frecuencia
de
embarazos
postvaricocelectoma fue del 50%, en
promedio a los 11 meses (2 34 meses).

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