The relationship between anogenital distance and the efficacy of varicocele repair

BJU Int. 2012 Dec;110(11 Pt C):E927-30. doi: 10.1111/j.1464-410X.2012.11154.x. Epub 2012 Apr 23.


Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Anogenital distance (AGD) is a marker of genital development and adult testicular function. To date, there is no data on the clinical utility of using such an anthropomorphic variable. About 30% of men will have no improvement in semen parameters after varicocele repair. It is currently difficult to assess which patients are most likely to benefit from surgical repair. The present study showed that men with a longer AGD had a higher likelihood of improvement after varicocelectomy. As such, AGD may allow clinicians to better counsel men on the efficacy of varicocele repair.

Objective: • To investigate whether anogenital distance (AGD) can identify men most likely to show improved semen parameters after varicocele ligation, as AGD has been shown to correlate with intrinsic adult testicular function.

Patients and methods: • Men with varicoceles who were evaluated at a men's reproductive health clinic in Houston were recruited. • AGD (the distance from the posterior aspect of the scrotum to the anal verge) was measured using digital callipers. • Logistic regression was used to compare outcomes after stratifying men based on AGD.

Results: • In all, 46 men with a mean (sd) age of 33.1 (6.3) years with postoperative semen data were recruited. • Semen concentration, motility, and total motile sperm count all showed significant improvement postoperatively (P < 0.01). • While 48% of men with a shorter AGD had improvements in sperm concentration postoperatively, 84% of men with a longer AGD improved (P = 0.01). • There was a trend toward a lower percentage of men (62% vs 84%) with shorter AGDs showing improvements in total motile sperm count (P = 0.09).

Conclusion: • AGD may provide a novel metric to assess intrinsic testicular function and predict efficacy of varicocele repair.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anal Canal / anatomy & histology*
  • Fertility*
  • Follow-Up Studies
  • Genitalia, Male / anatomy & histology*
  • Humans
  • Ligation
  • Male
  • Retrospective Studies
  • Sperm Motility / physiology*
  • Treatment Outcome
  • Urologic Surgical Procedures, Male / methods*
  • Varicocele / surgery*