Predictive Value of Vein Diameter Threshold and Clinical Factors in Semen Quality Improvement after Varicocelectomy

İngilizce (OpenAlex)

OBJECTIVE: To evaluate whether preoperative varicocele vein diameter predicts postoperative semen quality improvement after microsurgical varicocelectomy, to identify a threshold value, and to assess the influence of age and venous reflux on these associations. STUDY DESIGN: A descriptive cohort study. Place and Duration of the Study: Department of Urology, Manisa Celal Bayar University, Manisa, Turkiye, between June 2010 and August 2025. METHODOLOGY: A total of 108 men aged 18-40 years with unilateral left-sided varicocele who underwent subinguinal microscopic varicocelectomy for infertility were included; predefined exclusions were applied. Semen parameters [progressive motility, total sperm count, and Sperm Motility Index (SMI)] were averaged from two preoperative tests and compared with the best value at postoperative 6-12 months. The effects of vein diameter, age, and venous reflux on these outcomes were assessed using chi-squared, Mann-Whitney U, and Spearman tests. ROC analysis evaluated vein diameter as a predictor. A p-value of <0.05 was considered statistically significant. RESULTS: Larger preoperative vein diameter was associated with ≥40% motility improvement (p = 0.045) and ≥420% SMI improvement (p = 0.049). Receiver operating characteristic (ROC) analysis identified a 3.4 mm cut-off value for both motility and SMI, with AUC 0.61 and 0.63, respectively. Venous reflux correlated with greater motility improvement (p = 0.015), while older age correlated with SMI improvement (p = 0.019). CONCLUSION: Preoperative vein diameter predicts improvement in progressive motility and SMI after microscopic varicocelectomy; a 3.4 mm threshold shows modest discriminative ability. Venous reflux and age influence specific outcomes and may help guide counselling. KEY WORDS: Varicocele, Veins, Semen analysis, Semen quality.