Development of a predictive nomogram for microscopic inferior epigastric vein-internal spermatic vein surgery in male infertility with combined varicocele and nutcracker syndrome.

OBJECTIVE

To construct a microscopic inferior epigastric vein-internal spermatic vein model based on testis-related indexes in infertile men with asthenospermia for predictingtreatment efficacy.

METHODS

A total of 264 male infertile patients with oligoasthenospermia and varicocele combined with nutcracker syndrome who received treatment of the inferior epigastric-internal spermatic vein under the microscope were collected and retrospectively analyzed. They were divided into a training set (n = 185) and a verification set (n = 79). Demographic characteristics of the patients and testicular-related indicators were collected. Univariate and multivariate analyses were used to screen for risk factors affecting the surgical effect, and a predictive model was constructed. The nomogram was drawn and its clinical application value was evaluated.

RESULTS

Multivariate logistic regression analysis showed that testicular volume, sperm motility, testicular artery blood flow velocity, testosterone level, the degree of varicocele, and the severity of nutcracker syndrome were independent risk factors for the surgical outcome. The constructed predictive model performed well in the training set and the verification set, with the C-index being 0.849 and 0.847, respectively. Decision curve analysis showed that the model had clinical application value within a certain threshold probability range. The prognostic model displayed strong discrimination performance, as evidenced by external validation.

CONCLUSION

The predictive model and nomogram constructed based on testis-related indicators are valuable for evaluating the therapeutic effect of inferior epigastric-internal spermatic vein surgery under the microscope, and also helpful for clinicians to predict the surgical effect and formulate an individualized treatment plan.