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Asian Journal of Andrology 2016A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. If a semen analysis is not... (Review)
Review
A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. If a semen analysis is not obtained from the adolescent male, in the absence of other symptoms, the main clinical indication used by many urologists to recommend repair is testicular atrophy. The varicocele may result in testicular damage in some males causing testicular atrophy with impaired sperm production and decreased Leydig cell function, while in other males the varicocele may seemingly cause no ill effects. In adult men, varicoceles are frequently present and surgically correctable, yet the measurable benefits of surgical repair are slight according to a Cochrane review. While occurring more commonly in infertile men than fertile men, only 20% of men with a documented varicocele will suffer from fertility problems. Most varicoceles found in adolescents are detected during a routine medical examination, and it is difficult to predict which adolescent presenting with a varicocele will ultimately show diminished testicular function in adolescence or adulthood. As in adults, the mainstay of treatment for varicocele in adolescents is surgical correction. However, unlike an adult varicocelectomy (the microsurgical approach is the most common), treatment for an adolescent varicocele is more often laparoscopic. Nevertheless, the goals of treatment are the same in the adolescent and adult patients. Controversy remains as to which patients to treat, when to initiate the treatment, and what type of treatment is the best. This review will present the current understanding of the etiology, diagnosis and treatment of the adolescent varicocele.
Topics: Adolescent; Adult; Age Factors; Humans; Male; Testis; Varicocele; Young Adult
PubMed: 26698233
DOI: 10.4103/1008-682X.167724 -
European Urology Focus Jan 2023The benefits and harms of varicocele treatment versus observation in adult infertile males are still controversial. (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The benefits and harms of varicocele treatment versus observation in adult infertile males are still controversial.
OBJECTIVE
To systematically pool the evidence on outcomes of varicocele treatment (any surgical or radiological) versus observation in adult infertile men.
EVIDENCE ACQUISITION
A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Only prospective randomized and nonrandomized studies were included until November 2021. The primary outcome was pregnancy rate; the secondary outcomes were improvements in sperm concentration, normal morphology, and progressive sperm motility after treatment compared to baseline. Men ≥18 yr of age with any-grade varicoceles were included.
EVIDENCE SYNTHESIS
Of 557 articles identified, 12 were eligible for inclusion, involving 1357 patients. Varicoceles were treated surgically in ten and radiologically in four studies. Varicocele treatment improved pregnancy rates (odds ratio 1.29; 95% confidence interval [CI] 1.00-1.65; p = 0.048) and sperm concentration (mean difference 12.34 million/ml, 95% CI 3.49-21.18; p = 0.006) compared with observation. Proportions of spermatozoa with normal morphology and progressive motility were not statistically different from those with observation. However, considering treatment arm only, sperm concentration, progressive motility, and normal sperm morphology were improved compared with baseline. A subgroup analysis showed that the benefit of varicocele treatment is evident in men with an abnormal semen analysis. The main limitation is represented by the heterogeneity of the included studies, mostly in terms of study population, fertility of the partner, outcome evaluation, lack of long-term outcomes, and intermediate/high risk of bias.
CONCLUSIONS
Treatment of any-grade varicoceles may improve pregnancy rates and sperm concentration in adult infertile men, while benefits in sperm motility and normal morphology are less clear.
PATIENT SUMMARY
In this systematic review and meta-analysis of all published prospective trials on varicocele treatment, significant evidence emerged on its benefit in terms of improved pregnancy rates and sperm concentration, while benefits in sperm motility and morphology are less clear.
Topics: Pregnancy; Female; Humans; Male; Adult; Varicocele; Prospective Studies; Sperm Motility; Semen; Fertility
PubMed: 36151030
DOI: 10.1016/j.euf.2022.08.014 -
The Urologic Clinics of North America Feb 1995Currently, we recommend varicocele repair in adolescents when (1) the results of semen analysis are abnormal, (2) the volume of the left testis is at least 3 mL less... (Review)
Review
Currently, we recommend varicocele repair in adolescents when (1) the results of semen analysis are abnormal, (2) the volume of the left testis is at least 3 mL less than that of the right, (3) the response of either luteinizing hormone or FSH to Gn-RH stimulation is supranormal, (4) bilaterally palpable varicoceles are detected, or (5) a large symptomatic varicocele is present. When surgery is necessary, the Palomo approach significantly decreases the risk of operative failure and has facilitated "catch-up" growth of the left testis that is comparable to that after artery-sparing procedures. It is important to note that there is potential for impaired fertility whenever a palpable varicocele is present. Unfortunately, no test or group of tests can predict with absolute certainty whether an adolescent with a varicocele will be fertile or infertile. Therefore, it is important to observe untreated patients until they complete their families. Patients who are unwilling or unable to adhere to the follow-up protocol may be candidates for surgical intervention.
Topics: Adolescent; Humans; Infertility, Male; Male; Risk Factors; Semen; Testis; Varicocele
PubMed: 7855951
DOI: No ID Found -
Fertility and Sterility Jul 1977Over the past 25 years the association of varicocele with male subfertility has been repeatedly demonstrated and the beneficial effect of varicocele ligation in... (Review)
Review
Over the past 25 years the association of varicocele with male subfertility has been repeatedly demonstrated and the beneficial effect of varicocele ligation in infertile men with oligoasthenospermia has been documented. Since the precise mechanisms by which a varicocele affects spermatogenesis are still unclear, the proper approach to the management of "asymptomatic" varicoceles is controversial.
Topics: Adult; Female; History, 16th Century; History, 19th Century; History, 20th Century; Humans; Infertility, Male; Leydig Cells; Male; Methods; Middle Aged; Pregnancy; Renal Veins; Semen; Spermatogenesis; Spermatozoa; Testis; United Kingdom; United States; Varicocele
PubMed: 326581
DOI: 10.1016/s0015-0282(16)42669-5 -
Current Urology Reports Sep 2017Varicocele may play a significant role in a subset of patients presenting with male factor infertility. Despite its relatively high prevalence amongst subfertile men,... (Review)
Review
PURPOSE OF REVIEW
Varicocele may play a significant role in a subset of patients presenting with male factor infertility. Despite its relatively high prevalence amongst subfertile men, there has been controversy over the effectiveness of surgical treatments, patient selection, and when to administer treatment, particularly in the era of assisted reproductive technology.
RECENT FINDINGS
In line with earlier finding, recent evidence strongly suggests that varicocelectomy improves pregnancy rates and semen parameters. The currently available literature still does not clearly elucidate the answer to this question, due to flaws in retrospective study design. Patients undergoing subinguinal microsurgical varicocelectomy appear to have the highest pregnancy rates, and lowest complication rates, compared to other surgical approaches. Current research has given us a better understanding of the relationship between varicocele and infertility. Amongst men presenting with semen analysis abnormalities and varicoceles, including those patients presenting with non-obstructive azoospermia or couples with a significant male factor component failing previous attempts at in vitro fertilization, varicocelectomy may improve take home baby rates. More robust, prospective, controlled studies are needed to further clarify the population of subfertile men with varicocele most likely to benefit from varicocelectomy.
Topics: Humans; Infertility, Male; Male; Patient Selection; Varicocele
PubMed: 28718159
DOI: 10.1007/s11934-017-0713-8 -
Andrologia Dec 2017Microsurgical varicocelectomy is considered the gold-standard technique treating varicocele in both adults and adolescents, due to relatively more favourable outcomes... (Review)
Review
Microsurgical varicocelectomy is considered the gold-standard technique treating varicocele in both adults and adolescents, due to relatively more favourable outcomes and lower post-operative recurrence and complication rates. Despite of mounting literature on this topic, several aspects are still not well defined. We summarised the most recent literature and presented findings that might extend its indications. Microsurgical varicocelectomy and intracytoplasmic sperm injection are both effective to father a child for infertile men with clinical varicocele even for those with worst condition of spermatozoa, nonobstructive azoospermia, and prior varicocele repair has substantial benefits for couples with a clinical varicocele. Microsurgical subinguinal and inguinal varicocelectomy seem to have comparable effectiveness for adolescents and infertile men with varicoceles. However, the subinguinal approach may have some advantages to deal with painful varicocele. The superior outcomes of bilateral varicocelectomy for patients with clinical left varicocele and concomitant clinical right varicocele are justified, while the benefit is still uncertain for concomitant subclinical right varicocele. Varicocelectomy may have the potential to improve sexual function along with serum testosterone. In conclusion, indications for microsurgical varicocelectomy may be extended by the concomitant right and left clinical varicocele and sexual dysfunction with varicocele.
Topics: Azoospermia; Humans; Infertility, Male; Male; Microsurgery; Sperm Injections, Intracytoplasmic; Treatment Outcome; Varicocele
PubMed: 28671268
DOI: 10.1111/and.12827 -
Pediatric Clinics of North America Dec 2001The evaluation and management of adolescents with varicoceles continue to evolve. Current recommendations for repair are based on the findings of impaired testicular... (Review)
Review
The evaluation and management of adolescents with varicoceles continue to evolve. Current recommendations for repair are based on the findings of impaired testicular growth or spermatogenesis; however, with early evaluation and selective treatment, clinicians should be able to reduce the potential for future fertility problems significantly in adolescents with varicoceles.
Topics: Adolescent; Gonadotropin-Releasing Hormone; Humans; Male; Referral and Consultation; Semen; Varicocele
PubMed: 11732130
DOI: 10.1016/s0031-3955(05)70391-6 -
The Canadian Journal of Urology Feb 2006Varicocele is the most common diagnosis in men presenting to fertility clinics. Traditional indications for correction of varicocele include scrotal pain, testicular... (Review)
Review
Varicocele is the most common diagnosis in men presenting to fertility clinics. Traditional indications for correction of varicocele include scrotal pain, testicular atrophy, and infertility without other apparent causes. Adolescent varicocele correction is indicated if pain or testicular growth retardation is present. Following varicocelectomy most studies report improved semen parameters, increased serum testosterone, improvement in functional sperm defects, and the return of motile sperm in selected azoospermic men. However, conflicting data exists on pregnancy and fertility outcomes. Consistent data supporting the effectiveness of repairing subclinical varicoceles is sparse. Most authors generally agree that the primary effect of varicoceles is on testicular temperature. Varicoceles are diagnosed primarily by physical examination. Radiographic assessments are helpful when physical examination is inconclusive or when further objective documentation of a patient's condition is necessary. Several surgical approaches to varicocelectomy exist, each with its own advantages and drawbacks. We prefer the inguinal approach to varicocelectomy, except when there is a history of previous inguinal surgery. In such cases, the subinguinal technique is employed. Routine use of an operating microscope and a micro Doppler probe affords easier identification of vessels and lymphatics. Varicocele remains the most surgically treatable form of male infertility. Knowing the correct techniques of diagnosis and surgical correction ensures the best chance of successful outcomes in terms of post-operative morbidity, improved semen parameters, and pregnancy rates.
Topics: Adolescent; Adult; Humans; Male; Varicocele; Vascular Surgical Procedures
PubMed: 16526975
DOI: No ID Found -
Urologia Internationalis 2009Testicular varicocele or varicocele is one of the common causes of scrotal swelling. It is predominantly found in the adolescent and young adult age group and it can... (Review)
Review
Testicular varicocele or varicocele is one of the common causes of scrotal swelling. It is predominantly found in the adolescent and young adult age group and it can adversely affect testicular function in a variety of ways. There is a considerable debate about the effects of varicoceles on future fertility, but the current evidence suggests that varicoceles are found in a higher percentage among males attending the infertility clinics and that treatment of varicoceles is associated with increased spontaneous conception rates among infertile couples. In this article we give an overall view on the aetiology, adverse effects and management of varicoceles.
Topics: Adolescent; Adult; Humans; Male; Spermatozoa; Varicocele; Young Adult
PubMed: 19506401
DOI: 10.1159/000218523 -
European Radiology 1999Varicocele can be very easily diagnosed by physical examination and subsequently treated when it is painful or associated with testicular hypotrophy. However,... (Comparative Study)
Comparative Study Review
Varicocele can be very easily diagnosed by physical examination and subsequently treated when it is painful or associated with testicular hypotrophy. However, palpability of the spermatic vein and reflux in low grade or even questionable varicoceles can be difficult to assess without imaging modalities. This can be a common problem for all physicians treating hypofertile men to decide whether the varicele needs to be treated or not. However, a gold standard that defines the presence of a subclinical varicocele has not yet been established. The different diagnostic tools based on ultrasonography investigated these past years to define a flow reversal in incontinent spermatic veins are presented in the first part of this review, with emphasis on subclinical varicocele. In the second part, we present our experience, together with a review of the literature concerning embolization of the spermatic veins as an alternative to surgery to treat varicoceles.
Topics: Blood Flow Velocity; Decision Making; Embolization, Therapeutic; Humans; Ligation; Male; Phlebography; Retrospective Studies; Scrotum; Ultrasonography, Doppler, Color; Varicocele; Veins
PubMed: 10087130
DOI: 10.1007/s003300050706