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Nature Reviews. Urology Sep 2017The link between varicoceles and male infertility has been a matter of debate for more than half a century. Varicocele is considered the most common correctable cause of... (Review)
Review
The link between varicoceles and male infertility has been a matter of debate for more than half a century. Varicocele is considered the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention. In addition, improvements in semen quality after varicocelectomy do not always result in spontaneous pregnancy. Studies regarding possible pathophysiological mechanisms behind varicocele-induced infertility have tried to address these controversies. Oxidative stress seems to be a central mechanism; however, no single theory is able to explain the differential effect of varicoceles on infertility. As a consequence, careful patient selection for treatment based on couple fertility status, varicocele grade, and semen quality is critical for achieving a chance of a subsequent pregnancy. A substantial amount of data on the effects of varicocelectomy has been gathered, but inadequate study design and considerable heterogeneity of available studies mean that these data are rarely conclusive. Current evidence suggests a beneficial effect of varicocelectomy on semen quality and pregnancy outcomes in couples with documented infertility only if the male partner has a clinically palpable varicocele and affected semen parameters.
Topics: Humans; Infertility, Male; Male; Risk Factors; Treatment Outcome; Varicocele
PubMed: 28675168
DOI: 10.1038/nrurol.2017.98 -
Asian Journal of Andrology 2016Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence... (Review)
Review
Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence rates, anatomic causes of recurrence, and methods of management of recurrent varicoceles. The PubMed database was evaluated using keywords "recurrent" and "varicocele" as well as MESH criteria "recurrent" and "varicocele." Articles were not included that were not in English, represented single case reports, focused solely on subclinical varicocele, or focused solely on a pediatric population (age <18). Rates of recurrence vary with the technique of varicocele repair from 0% to 35%. Anatomy of recurrence can be defined by venography. Management of varicocele recurrence can be surgical or via embolization.
Topics: Adolescent; Adult; Age Factors; Child; Humans; Male; Phlebography; Recurrence; Risk Factors; Treatment Failure; Varicocele; Young Adult
PubMed: 26806078
DOI: 10.4103/1008-682X.171578 -
The Urologic Clinics of North America Feb 2014Varicoceles are an abnormal dilation of the pampiniform plexus of veins within the scrotum. Varicoceles are highly prevalent and can result in a myriad of deleterious... (Review)
Review
Varicoceles are an abnormal dilation of the pampiniform plexus of veins within the scrotum. Varicoceles are highly prevalent and can result in a myriad of deleterious effects on male reproduction. Numerous therapeutic options are available for correcting varicoceles, including surgical varicocelectomy and radiographic venous embolization. Varicocele correction is a more cost-effective therapeutic modality than both intrauterine insemination (IUI) and in vitro fertilization (IVF) for affected couples. In summary, varicoceles contribute significantly to male reproductive pathology, and varicocele correction is an important option for both clinicians and patients to consider in this era of assisted reproductive techniques.
Topics: Humans; Infertility, Male; Male; Phlebography; Varicocele
PubMed: 24286772
DOI: 10.1016/j.ucl.2013.08.001 -
Asian Journal of Andrology 2016Varicocele is a common problem in reproductive medicine practice. A varicocele is identified in 15% of healthy men and up to 35% of men with primary infertility. The... (Review)
Review
Varicocele is a common problem in reproductive medicine practice. A varicocele is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, especially regarding its effect on male infertility. We have conducted a systematic review of studies evaluating the epidemiology of varicocele in the general population and in men presenting with infertility. In this article, we have identified some of the factors that can influence the epidemiological aspects of varicoceles. We also recognize that varicocele epidemiology remains incompletely understood, and there is a need for well-designed, large-scale studies to fully define the epidemiological aspects of this condition.
Topics: Humans; Infertility, Male; Male; Varicocele
PubMed: 26763551
DOI: 10.4103/1008-682X.172640 -
Medicinski Pregled 2010Varicocele is the condition of abnormal venous dilatation of the pampiniform venous system presented at the upper pole of the testicle, sometimes associated with... (Review)
Review
Varicocele is the condition of abnormal venous dilatation of the pampiniform venous system presented at the upper pole of the testicle, sometimes associated with intratesticular varices. Dominantly presented on the left testicle, it is rarely noted on the right one or bilaterally. According to one interpretation, higher incidence in puberty can be accounted for by testicular blood flow increase in the testicular veins. Whatever the primary etiological factor may be, venous hypertension in the venous cord due to renospermatic venous reflux is a constant feature and is responsible for different pathological changes which occur in both the cord veins and the testicle. Vein congestion and heat exchange disturb and increase scrotal temperature having a negative effect on spermatogenesis and also induce irregular apoptosis in germ cells. Recently, reactive oxygen species production in association with decreased antioxidant capacity have been put under suspicion of deteriorating spermatogenesis. Varicoceles in adolescents are usually asymptomatic and the diagnosis is most frequently made according to the typical appearance by the routine annual school physical examination. Ultrasonography and Doppler mode are the most practical and non- invasive examinations. Semen analysis is possible three years after the onset of puberty when semen parameters reach adult values. Deterioration of spermatogenesis and infertility in adults could be accepted as a distant complication of adolescent varicocele. Many agree that indications for surgical intervention in adolescent are: pain, large varicoceles, hypotrophy of the involved testicle, bilateral varicocele, intratesticular varicocele and patients with abnormal semen parameters on serial evaluation. The ideal method for treating adolescent varicocele still remains controversial, but the main task is to decrease the number of recurrences and complications, while retaining optimum testicular function. Because of that, many surgeons respect the attitude "catch up growth".
Topics: Adolescent; Humans; Male; Varicocele
PubMed: 21548422
DOI: No ID Found -
Current Opinion in Urology Nov 2008Adult varicocele presents a challenge for male reproductive specialists. We have yet to fully elucidate the pathophysiology of varicocele. The enigma of the varicocele,... (Review)
Review
PURPOSE OF REVIEW
Adult varicocele presents a challenge for male reproductive specialists. We have yet to fully elucidate the pathophysiology of varicocele. The enigma of the varicocele, although a source of frustration for clinicians, has been a siren call for researchers as attested to by the substantial, if flawed body of literature on the topic. We critically review recent publications on varicocele.
RECENT FINDINGS
Although yielding mixed results, studies this year have explored the potential relationship between oxidative stress and varicocele-associated infertility. In clinically focused research, one group tackled the contentious question of efficacy of surgical varicocele management. Building on the errors of prior meta-analyses, this study takes a fresh view on an old but vital topic. Finally, it is becoming clearer that varicocele affects Leydig cell function as well as seminiferous tubular function, and is a risk factor for androgen deficiency.
SUMMARY
With exceptions, recent studies support a role for varicocelectomy in the management of infertile couples. In addition, evidence is accumulating that early repair of varicoceles, especially large varicoceles, may be effective in preventing future infertility and may be an effective treatment for androgen deficiency.
Topics: Adult; Female; Fertility; Humans; Infertility, Male; Male; Oxidative Stress; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Treatment Outcome; Urologic Surgical Procedures, Male; Varicocele
PubMed: 18832947
DOI: 10.1097/MOU.0b013e3283136493 -
The Urologic Clinics of North America Aug 1987Approximately one third of infertile men present with varicocele, while the incidence among males in the general public is approximately 15 per cent. The etiology may be... (Review)
Review
Approximately one third of infertile men present with varicocele, while the incidence among males in the general public is approximately 15 per cent. The etiology may be a longer left spermatic vein with its right-angle insertion into the left renal vein and/or absence of valves, which causes a higher hydrostatic pressure in the left spermatic vein causing dilatation. The nutcracker phenomenon is also a possible etiology. Much of the pathophysiology is still unknown, but increased blood flow causing an elevated intratesticular temperature may be of significance. Though there are many recent reports on the importance of a subclinical varicocele, we are not convinced of its significance. The best method for diagnosis remains a good clinical examination. The incidence of adolescents with varicocele is about the same as men with varicocele (approximately 15 per cent). Adolescents with varicocele should be treated if the testicular mass is decreased or if they are symptomatic. Surgical ligation is still the preferred method of treatment. Percutaneous treatment of varicoceles has an approximately 11 per cent incidence of minor complications and an occlusion rate of 73 per cent with a recurrence rate of 5 per cent. We reserve percutaneous treatment for recurrent varicoceles after surgical ligation, but primary percutaneous therapy is a reasonable approach.
Topics: Adolescent; Adult; Age Factors; Embolization, Therapeutic; Epididymis; Female; Humans; Infertility, Male; Ligation; Male; Phlebography; Pregnancy; Spermatic Cord; Testis; Ultrasonography; Varicocele; Veins
PubMed: 3303595
DOI: No ID Found -
Der Urologe. Ausg. A Mar 2020The prevalence of varicocele in children is less than 1% and in 11- to 19-year-old boys 8-14%. Up to 15% of patients with varicocele have impaired fertility. The... (Review)
Review
The prevalence of varicocele in children is less than 1% and in 11- to 19-year-old boys 8-14%. Up to 15% of patients with varicocele have impaired fertility. The indication for therapy of varicocele is still controversially discussed. In clinical trials testicular volume, volume difference, semen quality, fertility, hormones and pain have been investigated. The results are very heterogeneous for all parameters, so that the evidence level of recommendations for therapy of varicocele is very low. Nevertheless, the EAU guidelines recommend therapy of varicocele in children and young adults in case of small testis (volume difference >2 ml or 20%), additional cryptorchism, bilateral palpable varicoceles, symptomatic varicoceles and in case of pathological semen (in older boys). Microsurgical inguinal and laparoscopic procedures with preservation of lymph vessels have the best success and lowest complication rates.
Topics: Adolescent; Adult; Aged; Child; Cryptorchidism; Fertility; Humans; Infertility, Male; Laparoscopy; Male; Microsurgery; Semen Analysis; Testis; Treatment Outcome; Varicocele; Young Adult
PubMed: 32047954
DOI: 10.1007/s00120-020-01118-8 -
Fertility and Sterility Mar 2019The impact of clinical varicoceles on semen parameters and male infertility has long been established. In the era of assisted reproduction, clinical discussion has... (Review)
Review
The impact of clinical varicoceles on semen parameters and male infertility has long been established. In the era of assisted reproduction, clinical discussion has questioned the role of varicocelectomy, offering the potential to bypass, rather than treat, varicocele-associated male infertility. However, current literature supports improved semen parameters and reproductive outcomes following repair. This article presents the stepwise operative approaches to microsurgical varicocelectomy and discusses the recent publications on outcomes.
Topics: Fertility; Humans; Infertility, Male; Ligation; Male; Microsurgery; Risk Factors; Treatment Outcome; Urologic Surgical Procedures, Male; Varicocele
PubMed: 30827515
DOI: 10.1016/j.fertnstert.2019.01.002 -
Fertility and Sterility Jan 2017Brown JS, Dubin L, Hotchkiss RS. The varicocele as related to fertility. Fertil Steril 1967;18:46-56. "The fact that some men with varicoceles are fertile should not...
Brown JS, Dubin L, Hotchkiss RS. The varicocele as related to fertility. Fertil Steril 1967;18:46-56. "The fact that some men with varicoceles are fertile should not minimize the potentially detrimental role of this abnormality. It would be reasonable to claim that varicocele is uniformly detrimental. One might postulate that a fertile man with a varicocele would have better semen without this condition."
Topics: Fertility; History, 20th Century; Humans; Infertility, Male; Male; Phlebography; Predictive Value of Tests; Risk Factors; Spermatic Cord; Varicocele; Veins
PubMed: 27842996
DOI: 10.1016/j.fertnstert.2016.10.018