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Test

VIth ICA - Plenary Lecture - Varicocele WHO trial (1996)

Overview and Commentary on the Results of the World Health Organization Varicocele Trial

by TB Hargreave, United Kingdom

The benefits or otherwise of high ligation (Palermo procedure), undertaken either immediately or delayed for one year, in a WHO prospective clinical trial on 248 couples in 12 countries were first presented. The couples had been trying for pregnancy for at least one year, the male partner had a palpable varicocele and abnormal semen measurements and the female partner was apparently "fertile." Although the trial indicated that varicocele ligation was 2.5 times more effective than delayed treatment, the results were used to illustrate the difficulties in interpretation arising from bias, loss to follow up, protocol violation and other confounding features in studies of this nature. In a lively and provocative presentation, Dr. Hargreave compared and contrasted four published prospective randomized trials of varicocele treatment of smaller size than the WHO study and which had yielded conflicting results. While it is clear that semen measurements can be improved by the treatment, especially if applied in adolescence or early in the man's reproductive life, benefits through improvement in the pregnancy rate remain uncertain. This appeared to suggest that the age and fertility status of the female partner may be a crucial element in such studies. The lecture continued to review the disturbing incidence of varicocele in the post-pubertal period, to critically evaluate the accuracy of diagnosis of the condition, the basis for selection of patients for treatment, and many other features of this apparently progressive condition. The presentation provoked animated discussion.

The benefits or otherwise of high ligation (Palermo procedure), undertaken either immediately or delayed for one year, in a WHO prospective clinical trial on 248 couples in 12 countries were first presented. The couples had been trying for pregnancy for at least one year, the male partner had a palpable varicocele and abnormal semen measurements and the female partner was apparently "fertile." Although the trial indicated that varicocele ligation was 2.5 times more effective than delayed treatment, the results were used to illustrate the difficulties in interpretation arising from bias, loss to follow up, protocol violation and other confounding features in studies of this nature. In a lively and provocative presentation, Dr. Hargreave compared and contrasted four published prospective randomized trials of varicocele treatment of smaller size than the WHO study and which had yielded conflicting results. While it is clear that semen measurements can be improved by the treatment, especially if applied in adolescence or early in the man's reproductive life, benefits through improvement in the pregnancy rate remain uncertain. This appeared to suggest that the age and fertility status of the female partner may be a crucial element in such studies. The lecture continued to review the disturbing incidence of varicocele in the post-pubertal period, to critically evaluate the accuracy of diagnosis of the condition, the basis for selection of patients for treatment, and many other features of this apparently progressive condition. The presentation provoked animated discussion.

Geoffrey Waites, Switzerland