EFFECT OF PALOMA’S PROCEDURE ON MALE FERTILITY

Objectives: To study the effectiveness of Paloma’s procedure for varicocele in male fertility. Materials and Methods: This descriptive study was conducted on 50 patients over 3-year duration from Jan 2018 to Dec 2020 at Institute of Kidney Disease (IKD), Hayatabad Medical Complex, Peshawar. Infertile male Patients having varicocele, age range from 18 to 40 years were included in the study.  Cases having abnormal hormonal profile, urinary tract infection, testicular size less than 20 ml and recurrent varicocele were excluded. Varicocele in all cases was treated with high ligation (Paloma’s procedure) by open surgery.  All cases were advised semen analysis (4-5 days interval after sexual intercourse) before and at 3-6 months after operation.   Age, clinical grade of varicocele, side involved seminal volume, sperm density, activity and morphology were recorded of all participants.  Pre and post-operative seminal volume, sperm density, activity and morphology were compared using paired t test.  The level of significance was P less than or equal to 0.05. Results: The mean age was 27.12±5.19 years. Most of the varicocele were present on left side (n=44, 88%). Most common grade of varicocele clinically was grade III (n=24, 48%) followed by grade II (n=15, 30%).  Sperm density, activity, and morphology improved after varicocele surgery through high ligation technique which was very highly and statistically significant (P<0.001). Conclusion: Paloma’s procedure is safe and effective modality of treatment for varicocele affected sub-fertile males.