Infertility Role of Renospermatic Basal Reflow and Age on Semen Quality Improvement After Sclerotization of Varicocele Giovanni Liguori, Giangiacomo Ollandini, Giorgio Pomara, Antonio Amodeo, Michele Bertolotto, Giorgio Mazzon, Bernardino de Concilio, Stefano Bucci, Ignazio Gattuccio, Paolo Turchi, Emanuele Belgrano, and Carlo Trombetta OBJECTIVES To determine the relationship between renospermatic basal reflow at color Doppler ultrasound (CDU) evaluation and the improvement in seminal quality after sclerotization of varicocele, and the role of patients’ age. No clear predictive factors are available for selecting patients who will show a better seminal improvement after varicocele correction. METHODS Between 2002 and 2008 we selected 113 patients with left unilateral varicocele, meeting the criteria of low sperm density, no endocrinological failures and no varicocele recidivating. Varicocele correction was performed using the retrograde sclerotization technique or, if not possible, the anterograde one. Patients underwent a physical examination, follicle-stimulating hormone assessment, sperm analysis (density, motility, and morphologic analysis), scrotal ultra- sound, and CDU evaluation. Patients were divided into 5 groups using the CDU classification (Sarteschi). Three months postoperatively, they were assessed with the same protocol. Mean age was 32.2 years. RESULTS We found improvement in seminal quality among the entire population. We found no signifi- cance in differences among semen quality improvement in patients of different ages. Patients with basal renospermatic reflow at preoperative CDU evaluation (groups 3, 4, and 5) showed a better improvement in sperm density (+139%) than patients with no basal reflow (groups 1 and 2; +61%). CONCLUSIONS The presence of a basal reflow at preoperative CDU is a strong predictive factor of a better seminal quality improvement after varicocele correction. On the contrary, patient’s age showed no significant relationship. UROLOGY 75: 1074 –1078, 2010. © 2010 Elsevier Inc. V aricocele is frequently diagnosed among infertile male population: 35%-40% of men with primary and 75%-80% of men with secondary infertility 1 according to different authors. Moreover, it is considered the most frequently encountered surgically correctable cause of male infertility, but clear predictive factors of a better outcome after its correction are still lacking. Sperm concentration, motility, and percentage of normal sperm cells are typically altered in infertile men with varicocele. 2,3 Even the role of varicocele correction in improving these parameters is still debated. 1,2,4 Sev- eral studies related different preoperative parameters with the effectiveness of surgical varicocele correction: mainly varicocele size, classification, and age of pa- tients treated. 5-7 However, the role of these parameters in the effectiveness of varicocele correction is not com- pletely clear too. The goal of our prospective study was to demonstrate the importance of renospermatic basal re- flow at the color Doppler ultrasound (CDU) preoperative investigation as the main predictive factor of a better improvement in seminal parameters after sclerotization of varicoceles. Moreover, we also studied patients’ age to determine whether this was related to different results in semen quality improvement after sclerotization. MATERIAL AND METHODS Patients Between 2002 and 2007, a total of 161 patients presented to our clinic with a unilateral left varicocele, because of either infer- tility at least 1 year in duration or scrotal pain. Patient age ranged from 18 to 44 years (mean, 32.2). All patients under- went a complete history, physical examination in a warm room, assessment of follicle-stimulating hormone value, semen anal- ysis, and scrotal ultrasonography with color-flow Doppler ex- From the Department of Urology, University of Trieste, Trieste, Italy; Urology Unit, Azienda Ospedaliera Pisana, University of Pisa, Pisa, Italy; Department of Radiology, University of Trieste, Trieste, Italy; Urology Unit, Palermo, Palermo, Italy; and Andrology Unit, Department of Urology, Prato Hospital, Prato, Italy Reprint requests: Dr. Giovanni Liguori, M.D., Ph.D., Department of Urology, University of Trieste, Via Tagliapietra 4, 34123, Trieste, Italy. E-mail: gioliguori@ libero.it Submitted: August 27, 2009, accepted (with revisions): October 26, 2009 1074 © 2010 Elsevier Inc. 0090-4295/10/$34.00 All Rights Reserved doi:10.1016/j.urology.2009.10.068