Comparison Of The Therapeutic Effects Of Microscopic Versus Renovated Palomo Varicocelectomy For Primary Varicocele In Army Personnel

BackgroundVaricoceles are dilated and tortuous testicular veins of the pampiniform plexus of the spermatic cord. As the high strength training, varicocele became a high incidence of disease in the soldiers. Varicocele can cause scrotal pain, and scrotal pain will aggravated with the training. Varicocele also can affect the testicular spermatogenesis, leading to male infertility; harm the mental health, the disease will influence the battle effectiveness of the army. The operation to treat varicocele can effectively prevent venous reflux, avoid the local blood stasis damage to testis, and make the most of patients with testicular sperm functional improvement. The main means of our hospital in the treatment of varicocele is retroperitoneal high ligation operation (Palomo). With adjustment of the establishment in our hospital, we treated a large munber of army patient with varicocele in recent years. Found by follow-up of patients with postoperative, army of postoperative patients with chronic pain and hydrocele of the scrotum was significantly higher than that in the Navy and local patients. Especially patients with chronic scrotum pain always repeated treatment, which can not be normal training. At present, there is no such in-depth research reports about selection of operation, postoperative complications in high fitness training patients.We were attracted by the new clinical problem, and hope to solve these problems by improving operation. Varicocele is an important cause of infertility, and operation is an effective method for treatment of infertility caused by varicocele. But now selection of operative mode is controversial, and is not yet clear of the differences in improving fertility, however, the investigation in varicocele patients psychological still less at present.The soldiers mental health is influenced by forces attention, therefore, we hope to provide better operation mode for patients with varicocele. We will use SDS and SAS to investigate the psychological status of patients with varicocele, and provide a theoretical basis for the psychological intervention.Part IPostoperative complications of microscopic versus Renovated Palomo varicocelectomy for primary varicocele in army personnelObjectiveTo comparison of the postoperative complications of microscopic or renovated palomo varicoceletomy in army patients with primary Varicoceles of GradeⅢ.MethodsA total of260army personnel with varicocele were randomized to receive microscopic varicocelectomy (group A, n=130) and renovated Palomo varicocelectomy (group B, n=130). The postoperative recurrence and complications (soermatic and testicular hydrocele, testicular pain and testicular atrophy) were compared between the two groups.ResultsAfter1year of follow-up, the recurrence rates in groups A and B were statistically comparable (5.3%vs3.8%, P=0.545). The incidences of testicular atrophy and soermatic and testicular hydrocele were significantly lower in group A than in group B (0.7%vs3.1%, P=0.005;3.1%vs14.6%, P=0.001), and the rate of testicular pain relief was significantly higher in group A (90.7%vs67.7%, P=0.000). ConclusionMicroscopic varicocelectomy can be a good choice in the treatment of varicocele in army personnel.Part IIComparison of the therapeutic effects of microscopic or Renovated Palomo varicocelectomy on Testicular Function in Patients with Varicoceles of GradeⅢObjectiveTo comparison of the therapeutic effects of microscopic or Renovated Palomo varicocelectomy on Testicular Function in Patients with Varicoceles of GradeⅢ, including the change of semen Parameter and serum reproductive hormones levels before and after varicocelectomy.MethodsAll50army patients with grade Ⅲ varicocele were randomly divided into two groups, group A(n=25)was treated with microscopic varicocelectomy, group B (n=25) was treated with Renovated Palomo varicocelectomy. The therapeutic effects of the two operative methods were compared, such as serum level of follicle stimulating hormone(FSH), Luteinizing hormone(LH), testosterone(T), inhibin B(INHB), sperm density, the amount of sperm and the proportion of sperm in grade(a+b).ResultsAfter3months and6months of follow-up, Sperm density, the amount of sperm, the proportion of sperm in grade(a+b), serum testosterone(T) and serum level of inhibin B were all significantly increased after operation in two groups compared with that before operation (p=0.000). Serum hormone (FSH) and Luteinizing hormone (LH) were significantly decreased after operation in two groups compared with that before operation (p=0.000). The degree of sperm motility and serum level of inhibin B increase were significantly higher in A group than that in B group (p=0.000, p=0.001). The degree of LH and FSH decrease were significantly higher in A group than that in B group (p=0.000, p=0.001). There were no significant differences in the degree of Sperm density increase, the degree of the amount of sperm increase and the degree of testosterone (T) increase between A group and B group.ConclusionBoth of the two operative options can improved spermatogenesis in patients with varicocele of Ⅲ grade, while patients may be get more benefit from treatment by Microsurgical varicocelectomy.Part ⅢSurvey Of psychological status of patients with varicocele of grade Ⅲ using SDS and SASObjectiveTo survey Of psychological status of patients with varicocele of grade Ⅲ using SDS and SAS, Explore the relationship between psychological status of patients and spermatogenesis.MethodsSelf-rating depression scale(SDS) and self-rating anxiety scale(SAS) were used to test on100army patients with varicocele of grade Ⅲ, to evaluate the relationship between psychological conditions and semen parameters, clinical symptoms, informed position.ResultsScore of SDS and SAS of patients with varicocele were obviously higher than that of norms in chinese army men. Standard score of SDS and SAS were obviously affected by clinical symptoms, informed position. Score of SDS and SAS in sperm motility abnormal group was significantly higher than that in the normal group (p<0.05). There was no significant difference in score of SDS and SAS between sperm density abnormal group and normal group (p>0.05).ConclusionDepression and anxiety were generally found in patients with varicocele of grade Ⅲ. Patients who without knowledge, severe clinical symptoms have more psychological disorders of depression and anxiety. Anxiety and depression may affect the function of testicular spermatogenic.