EFFICACY OF SPERMATIC VEIN LIGATION IN PATIENTS AFFECTED

BY HIGH GRADE LEFT VARICOCELEPembimbing :

Prof. DR. dr. H Rifky Muslim, Sp. B, Sp. UOleh :

Afifatul Hakimah 01.209.5822

Kepanitraan Klinik Ilmu Bedah

RSI Sultan Agung Semarang

2014

JOURNAL IDENTITY•Efficacy of Spermatic Vein Ligation in Patients Affected by High Grade Left VaricoceleTitle•Marco Grasso, Caterina Lania, Salvatore Blanco, Silvia Confalonieri, Angelica A. C. GrassoAuthors •February 2014Date of

published•International Brazilian Journal UrologyPublished by

INTRODUCTIONVaricocele

elongation

and enlargemen

t of the network of

veins leaving the testis that

join to form the

testicular vein.

20-24% in the adult

male population

with a higher

prevalence in the left

side.

The condition is

more common in

men in infertile

marriages, in which it affects 25-

40% of men with abnormal

semen analysis

The exact association

between reduced

male fertility and varicocele

is not known

because prospective randomized studies on varicocele treatment in adults

have given conflicting

resus

MATERIALS & METHODSFrom January 2006 to

February 2011high grade left varicocele

who presented with infertility

Inclusion criteria:• infertility persisting

for more than 1 year despite regular, unprotected intercourse;

• abnormal semen pa-rameters as assessed by World Health Organiza-tion (WHO) guidelines 2010;

Exclusions :• other infertility-

related disease : : history of maldescended testis, infections, general diseases, or chronic medication

• obvious causes of infertility in the subject’s partner : anovulation, endometriosis, tubal blockage75

patients.

RESULTS All 75 patients had 3rd grade left varicocele Two patients were

excluded because of basal continuous reflux after surgery.

Age• The patients’ mean age was 33.2 years (range 23-48 years)• The mean age of the partners was 28.5 years (range 23-39

years). Infertility• The mean infertility period was 23 months (SD ±8.4, range

12-39 months).History• No patient reported previous episodes of

cryptorchidism,hydrocele, or testicular trauma, nor had they undergone surgery of the urogenital tract.

• No other causes of infertility were found.Pregnancy preoperative• During the 6-9 months preoperative period while patients were on the surgery waiting list, pregnancy was achieved in 1 couple (1.3%)Follow up time

• The mean study follow-up time was 32.4 months (range 24-47 months)

DISCUSSION The main point of discussion is the clear

benefit for the rate of pregnancy when varicocele is treated in infertile patients if other causes of male infertility, as well as obvious causes of female infertility, are ruled out. However, this point is debated by the scientific literature because even prospective randomized controlled trials of varicocele treatment in adults have given conflicting results.

Strengths of the study :•Journal method might be closer to real clinical practice than randomized clinical trials that have a higher percentage of randomization refusal. The same patients are their own controls because seminal parameters and pregnancy rate are measured before and after surgical treat-ment for varicocele in the same population.•Only 3rd grade varicocele according to color Doppler classification was taken into consideration differently from previous randomized studies that usually consider clinical classifications, which are known to have low sensitivity positive results for pregnancy rate and improved seminal parameters

Limitations of the study :•We did not have a con-trol group for comparison with our treatment data. We agree that a control would be ideal to provide high level evidence of treatment benefits, but is ethically questionable to exclude a well-defined patient group from a recommended therapy.

CONCLUSION

The surgical treatment of high grade varicocele effectively treats

infertility, improving seminal parameters and pregnancy rate.

CRITICAL APPRAISALThe structure and content of journal

The title of the journal Positive

Consist of variables studied : yes Bold : yes No abbreviation : yes The structure : >12 words (13)

Negative -

The author and institution Appropriate with the guidelines : yes

ABSTRACT The structure

consist of 4 parts: purpose, materials and methods, results, conclusion. There are key words

Informative : yes Less than 250 words : no (276)

INTRODUCTION Consist of two paragraph or part : 3 paragraphs The first paragraph explain background of the research :

yes The second paragraph explain hypothesis or objective : yes Less than one page : yes

METHOD Design of The Research

Prospective study non randomized Inclusion and exclusion criteria:

mentioned Study selection: mentioned Analytical studies: mentioned Outcome: mentioned

RESULT Characteristic of studies: included Accuracy of numeric data: trusted Accuracy and compatibility of analytic

computer program: trusted The result of analysis: included

Discussion

The strengths & limitation: was written Comparison with other studies: included

Literature

The structure: appropriate with guidelines Appropriate any citation: yes

• Patient with high grade left varicoceleP

•Spermatic vein ligature through an inguinal approach with optical magnificationI•-C •The achievement of pregnancy and semen parameters during postoperative periodO

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