Varicocele na adolescência: avaliação dos efeitos a longo prazo em pacientes tratados e não tratados
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Data
2023-11-28
Autores
Groner, Matheus Ferreira [UNIFESP]
Orientadores
Fraietta, Renato [UNIFESP]
Tipo
Tese de doutorado
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ISSN da Revista
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Objetivo: A varicocele tem início na adolescência e seus efeitos deletérios podem diminuir o potencial fértil progressivamente, sendo bem documentado que seu tratamento pode melhorar esse potencial a curto prazo, porém, ainda são escassas as evidências de melhora a longo prazo. O objetivo deste trabalho foi avaliar o potencial fértil, a longo prazo, de pacientes com diagnóstico de varicocele tratados e não tratados durante a adolescência. Método: O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo – UNIFESP, sendo elaborado um desenho longitudinal de coorte retrospectivo em que os pacientes foram convocados e avaliados no Setor Integrado de Reprodução Humana da UNIFESP, durante a adolescência, então diagnosticados com varicocele grau II ou III. Neste momento inicial esses pacientes foram observados (Grupo não operado) ou operados pela técnica de Marmar (Grupo operado) se apresentassem indicação clínica. Durante o desenvolvimento do projeto, foram reavaliados clinicamente e através de análise seminal e de avaliação funcional dos espermatozoides através de análise de Integridade do DNA espermático, atividade mitocondrial e integridade do acrossoma, para determinar o atual potencial fértil. Resultados: Foram avaliados 33 pacientes, sendo 14 do grupo não operado e 19 do grupo operado. Foram excluídos 4 pacientes do grupo operado devido à recidiva. O intervalo entre as avaliações foi em média de 10 anos. Quanto à análise seminal, no grupo não operado, houve uma diminuição significativa da motilidade progressiva (p = 0,009). No grupo operado houve aumento significativo da concentração espermática (p = 0,003), do número total de espermatozoides móveis (TSM) (p = 0,003) e do número total de espermatozoides móveis morfologicamente normais (TSMMN) (p = 0,004). Na avaliação funcional dos espermatozoides, não houve diferença estatisticamente significativa. Conclusões: O tratamento da varicocele na adolescência pode impactar positivamente no potencial fértil, sendo observada uma melhora significativa e progressiva dos parâmetros seminais no grupo operado, mantida após 10 anos de tratamento. Há indícios de uma piora na motilidade progressiva em adolescentes não operados, potencialmente sem relevância clínica.
Objective: Varicocele onset is from the beginning of adolescence and its deleterious effects can reduce fertility potential. It is well documented that its treatment leads to a shortterm improvement, but there is still low evidence of longterm improvement after treatment. The objective of this study is to evaluate the longterm fertility potential of patients diagnosed with varicocele, treated and untreated during adolescence. Methods: This study was approved by the Research Ethics Committee and a longitudinal retrospective cohort study was carried out in patients evaluated during adolescence who were recruited, and were then diagnosed with varicocele. At this initial moment, these patients were observed (nonoperated group) or operated by the Marmar technique (operated group). During the development of the project, they were reassessed clinically and through semen analysis and sperm functional evaluation to determine the current fertility potential, excluding patients with other fertility loss factors or recurrent varicocele. For statistical analysis in this study an alpha error of 0.05 (p<0.05) was adopted. Results: Thirtythree patients were evaluated, 14 from the nonoperated group and 19 from the operated group. 4 patients were excluded from the operated group because they had clinical recurrence. The interval between evaluations was on average 10 years. As for the seminal analysis, in the nonoperated group, when comparing the initial and current seminal analysis, there was a significant decrease in progressive motility (p = 0.009). In the operated group, there was a significant increase in sperm concentration (p = 0.003), total motile sperm count (p = 0.003) and total motile sperm count with normal morphology (p = 0.004). In terms of the sperm functional evaluation, there was no significant difference when comparing the current groups or the initial and final evaluation of the operated group. Conclusions: We observed that the nonoperated group, after 10 years, presented a progressive motility decrease in semen analysis, but potentially with no clinical relevance. In the operated group, there was a longterm improvement in fertility potential, even with no significant improvement in shortterm revaluation, after 10 years the semen analysis of the operated group is similar to patients without varicocelectomy indication.
Objective: Varicocele onset is from the beginning of adolescence and its deleterious effects can reduce fertility potential. It is well documented that its treatment leads to a shortterm improvement, but there is still low evidence of longterm improvement after treatment. The objective of this study is to evaluate the longterm fertility potential of patients diagnosed with varicocele, treated and untreated during adolescence. Methods: This study was approved by the Research Ethics Committee and a longitudinal retrospective cohort study was carried out in patients evaluated during adolescence who were recruited, and were then diagnosed with varicocele. At this initial moment, these patients were observed (nonoperated group) or operated by the Marmar technique (operated group). During the development of the project, they were reassessed clinically and through semen analysis and sperm functional evaluation to determine the current fertility potential, excluding patients with other fertility loss factors or recurrent varicocele. For statistical analysis in this study an alpha error of 0.05 (p<0.05) was adopted. Results: Thirtythree patients were evaluated, 14 from the nonoperated group and 19 from the operated group. 4 patients were excluded from the operated group because they had clinical recurrence. The interval between evaluations was on average 10 years. As for the seminal analysis, in the nonoperated group, when comparing the initial and current seminal analysis, there was a significant decrease in progressive motility (p = 0.009). In the operated group, there was a significant increase in sperm concentration (p = 0.003), total motile sperm count (p = 0.003) and total motile sperm count with normal morphology (p = 0.004). In terms of the sperm functional evaluation, there was no significant difference when comparing the current groups or the initial and final evaluation of the operated group. Conclusions: We observed that the nonoperated group, after 10 years, presented a progressive motility decrease in semen analysis, but potentially with no clinical relevance. In the operated group, there was a longterm improvement in fertility potential, even with no significant improvement in shortterm revaluation, after 10 years the semen analysis of the operated group is similar to patients without varicocelectomy indication.
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Citação
GRÖNER, Matheus Ferreira. Varicocele na adolescência: avaliação dos efeitos a longo prazo em pacientes tratados e não tratados. 2023. 65 f. Tese (Doutorado em Urologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.