Evaluation of Varicocelectomy in the Urology-Andrology Department of the Peace Hospital of Ziguinchor: Report of 52 Cases

Abstract

Introduction: Varicocele is a significant cause of male infertility and represents one of the most frequent reasons for consultation in urology and andrology services in Senegal. In sub-Saharan African societies, infertility in couples has long been considered a taboo subject, often placing social pressure primarily on women. The diagnosis of varicocele is mainly clinical but can be supplemented with scrotal Doppler ultrasonography. Treatment for varicocele associated with altered semen parameters may involve surgery (open or laparoscopic) or radiological embolization. The therapeutic choice depends on both the surgeon and the patient. The objective of this study was to evaluate the outcomes of varicocelectomy performed in the Urology-Andrology Department of the Peace Hospital of Ziguinchor. Patients and Methods: This was a retrospective, descriptive study conducted over a period of four (04) years, from January 2019 to December 2022. The parameters analyzed included epidemiological, diagnostic, therapeutic, and follow-up data. Results: A total of 930 patients were managed for urogenital pathologies, of whom 8% (n = 70) were treated for male infertility associated with varicocele. The age group 30 - 39 years accounted for 49% of patients. All patients consulted due to a desire for fatherhood. Primary infertility was observed in 75% (n = 39) of cases. A history of urological infection was found in 7.7% (n = 4) of patients. Active smoking was reported in 17% (n = 9), and alcohol consumption in 11.5% (n = 6). Varicocele was bilateral in 90% of cases. Semen analysis was abnormal in 98% (n = 51) of patients, with oligo-astheno-terato-necrozoospermia being the most common combination of abnormalities, found in 32.7% (n = 17). Seminal cytobacteriological examination, performed in 37% (n = 19) of patients, did not isolate any pathogens. Hormonal assays (testosterone and FSH) were performed in 10% (n = 5), showing low testosterone levels (2 cases). Scrotal Doppler ultrasound revealed bilateral varicocele in 94% (n = 49) of patients. Open surgery was performed in 71% (n = 37), while laparoscopy was used in 29% (n = 15). During follow-up between 3 and 9 months, we observed normalization of all sperm parameters in 34.6% (n: 18) of patients. Within an average of five (5) months after surgery, 38.5% (n = 20) of natural pregnancies were achieved. Conclusion: Varicocele is a common male condition, with an even higher incidence among infertile men. Varicocelectomy appears to play an essential role in the management of men with varicocele and abnormal semen parameters, in the absence of other causes.