Abstrakt

Does Left Varicocele Impair Right Testicular Function?

Salvatore Arena, Carmine Fazzari, Antonio Campione, Pietro Antonuccio, Tiziana Russo, Patrizia Perrone, Lucia Marseglia, Eloisa Gitto, Carmelo Romeo

Introduction: Varicocele is considered the most common cause of infertility in men. While impairment of the ipsilateral testis has been assessed, impact on the contralateral right testis is unclear. The aim was to evaluate the activation of apoptosis and histological lesions of the right testis in a model of left varicocele and to assess changes after varicocelectomy.

Methodology: Twenty-one male Sprague-Dawley rats were used. After the creation of experimental left varicocele, rats were randomized for no other procedure or varicocelectomy, lasting 21 days. Sham animals were used as controls. Animals were then euthanized and expression of active caspase 3 through western blot and spermatogenetic activity were assessed on the harvested right testis. Quantitative parameters were compared. A p<0.05 was considered significant. Results: Active caspase 3 was present in right testis of sham at the basal level. A significant increase in active caspase 3 was found in right testis of left varicocele and weak enhancement of active caspase 3 was detected in right testis after left varicocelectomy. Jonhsen's score of right testis of sham was 9.57 ± 0.50, which was significantly higher than the value obtained from right testes of rats with left varicocele [8.74 ± 1.00, p<0.0001]. Jonhsen's score after varicocelectomy was 9.19 ± 0.77, significantly different from right testes of sham [p=0.0029] and from right testes of the varicocele group [p=0.0088]

Discussion: Our study shows activation of apoptosis and a decrement of spermatogenic activity in the right testis in a model of left varicocele. It supports the theory that left varicocele impairs testicular function bilaterally. Left varicocelectomy ameliorates apoptosis and testicular lesions but does not restore initial spermatogenic activity. It could explain why surgical treatment of clinical left varicocele does not always improve fertility.