Clinical Outcomes Of Microsurgical Varicocelectomy And Seminal Dysbiosis In Varicocele Patients

Aim:We investigated the effect of microsurgical varicocelectomy on semen parameters and to demonstrate whether the unbalanced seminal microbiome is associated with low seminal quality in patients with varicocele.Method:From March 2015 to December 2016,a total of 90 patients diagnosed as varicocele in the First Affiliated Hospital of Zhejiang University School of Medical were included in the clinical study.Of which 31 were included in the study of microecology.All the varicocele patients underwent microsurgical varicocelectomy.Semen and blood samples were collected before and at least 3 months after surgery.The seminal microbial community was investigated by Hiseq sequencing of the 16S ribosomal V3-4 region.Results:For the 90 patients who underwent microsurgical varicocelectomy the total motile count,sperm motility(A+B),sperm concentration and total sperm count increased significantly by 3 months after surgery(30.12±17.34%VS 45.68±21.21%,p<0.0001;23.92±13.96%VS 37.36±19.33%,p<0.0001;41.56±40.06 million/ml VS 56.491±60.22 million/ml,p=0.03;148.54±157.96 million VS 221.82±241.66 million,p=0.005,respectively).For the patients 6 months after surgery semen parameters also increased significantly(30.12±17.34%VS 43.40±17.09%,p=0.0003;23.92±13.96%VS 36.07±14.37%,p=0.0005;41.56±40.06 million/ml VS 49.84±26.82 million/ml,p=0.008;148.54±157.96 million VS 216.99±155.89 million,p=0.02,respectively).No further improvement in semen parameters were observed in those men for more than 3 months.There were no significant improvement in semen parameters comparing the results at 3,6 months postoperatively.In the group with abnormal preoperative semen quality,results of semen analyses improved significantly after surgery.However there were no significant improvement in the group with normal preoperative semen quality.Higher diversity and a distinct change in the seminal microbiome were found in patients with varicocele.Compared with normal volunteers,varicocele patients had more phylum Bacteroidetes and Firmicutes(p<0.05)and less Proteobaceria(p<0.05).Several orders and genera,such as Clostridiales(order),Pseudomonadales(order),Corynebactriales(order),Anaerococcus(genera)and Pseudomonas(genera),which might be related with inflammation,were significantly increased in seminal fluids of varicocele patients.The seminal microbial flora had a significant correlation with the semen parameters,the width of spermatic vein and hormones.22 varicocele patients with poor seminal quality had altered seminal microbiome compared with both 9 varicocele patients with normal seminal quality and healthy individuals.Interestingly,the seminal microbial flora had a trend to normal status along with an improvement of the semen parameters after surgery in varicocele patients with asthenospermia.Conclusion:Microsurgical varicocelectomy can significantly improve the semen quality of patients with abnormal preoperative semen quality.There were no significant improvement in semen parameters comparing the results at 3,6 months postoperatively,and still requiring longer follow-up and larger sample size to verify the result.Seminal dysbiosis was found in varicocele patients,which could be a novel mechanism for low seminal quality caused by varicocele.