Preoperative Systemic Immune-Inflammation Index as an Independent Predictor of Varicocelectomy Success
DOI:
https://doi.org/10.58600/eurjther3069Keywords:
male infertility, semen improvement, systemic immune-inflammation index, varicocele, varicocelectomyAbstract
Objective: Varicocele is a common and surgically correctable cause of infertility in men; however, postoperative improvement in semen parameters varies considerably among patients. Inflammation plays an important role in varicocele-related testicular dysfunction, and hematologic inflammatory indices have recently gained attention as potential prognostic markers. The systemic immune-inflammation index (SII) is a novel and easily accessible marker that may reflect the underlying inflammatory burden influencing postoperative outcomes. We aimed to investigate the association between preoperative SII and varicocelectomy success.
Methods: One hundred ninety-one patients who underwent microsurgical subinguinal varicocelectomy between January 2018 and January 2024 were retrospectively reviewed. Patients with azoospermia, hormonal therapy, prior scrotal surgery, malignancy, hematologic or systemic inflammatory disorders, or subclinical varicocele were excluded. Preoperative blood samples were collected to calculate SII (neutrophil × platelet / lymphocyte), and semen analyses were performed before and six months after surgery. Varicocelectomy success was defined as a >50% increase in total motile sperm count (TMSC) in the postoperative semen analysis (but >100% increase is required if the preoperative TMSC was <5 million). Patients were divided into two groups based on postoperative semen improvement: Group 1 (improvement) and Group 2 (no improvement).
Results: Postoperative semen improvement was observed in 122 patients (63.9%). Preoperative SII was significantly lower in Group 1 compared to Group 2 (median 345.2 vs 441.1, p<0.001). ROC analysis identified an SII threshold of ≤ 363.7 for predicting varicocelectomy success (AUC:0.766, 95% CI:0.699-0.832). Multivariate analysis revealed that preoperative sperm motility (p=0.029) and SII≤363.7 (p<0.001; OR=5.465) were independent predictors of varicocelectomy success.
Conclusion: Lower preoperative SII values are significantly associated with better postoperative semen outcomes following microsurgical subinguinal varicocelectomy. SII, as a simple and cost-effective inflammatory marker, may serve as a practical tool for preoperative assessment and counseling in infertile men undergoing varicocelectomy.
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Copyright (c) 2026 Deniz Gül, Kemal Demirhan, Hacı İbrahim Çimen, Anıl Erdik, Recep Burak Değirmentepe, Ahmet Gökçe
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