(870) High Grade Varicocele Treated with Embolisation Improves Semen Parameters More Than Surgical Ligation

Introduction It is well established that both microsurgical varicocelectomy (MSV) and radiological embolisation (RE) can improve sperm parameters in men with abnormal sperm counts. RE has the advantage to be done under local anaesthesia. However, their relative effectiveness in improving semen parameters remains unclear. Objective This study compares changes in sperm parameters after MSV or RE, adjusting for baseline semen, hormonal and testicular parameters. Methods A retrospective study was carried out on adult male patients with varicocele who underwent MSV or RE between 2017 and 2025 at a single centre. Patients with baseline and repeat semen analyses 14 weeks or more after treatment were included. A multivariate analysis was used to compare marginal means in post-treatment changes in total motile sperm count (TMSC), concentration and motility between MSV and RE. The linear model was adjusted for age, baseline semen parameters, testicular volume on initial ultrasound, and pre-treatment testosterone. Results A total of 82 men were included (RE n = 56; MSV n = 26) with a median age of 37 (IQR 32–41.3). Pre-treatment median TMSC, sperm concentration, and motility was 2.73 million (IQR 0–16.79), 3.55 million/ml (IQR 0–17.65) and 21% (IQR 0–41). In the subgroup analysis of 43 men with clinical grade 3 or Sarteschi grade 3 or above varicoceles (RE, n = 31; MSV, n = 12), treatment modality was the only significant factor on improvement of semen parameters (p = 0.013) after adjusting for covariates including semen parameters, testicular volume, age, and pre-surgery testosterone. RE produced a statistically significant greater change in sperm motility compared with MSV (mean 8.83% vs –2.47%, F(1,35) = 4.67, p = 0.04), while differences in TMSC and sperm concentration were not statistically significant (TMSC: 18.81 vs –1.94, p = 0.107; concentration: 6.95 vs 2.23, p = 0.467). Notably, 10 men underwent MSV after previous RE. 60% and 70% of men benefited in sperm concentration and motility respectively. Conclusions In this study, men with high grade varicocele treated with RE had a greater improvement in sperm motility compared with MSV, while improvement in TMSC and concentration were similar. The majority of men benefited from MSV in recurrent high-grade varicocele after RE. Disclosure No