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Asian Journal of Andrology 2016It was more than 40 years ago, as a first-year Urology resident, that I performed my first varicocele ligation (a Palomo procedure1) under the watchful eye and able...
It was more than 40 years ago, as a first-year Urology resident, that I performed my first varicocele ligation (a Palomo procedure1) under the watchful eye and able hands of my staff physician. I dutifully read all I could the night before the procedure and became familiar with the names of Barfield, Macomber and Sanders, Tulloch, MacLeod, Ivanissevich, Palomo, Amelar and Dubin and others who had written about varicoceles being associated with abnormal semen parameters and a potentially surgically correctable cause of male infertility. During and after our uneventful surgical procedure, I was grilled as to the anatomy and known pathophysiology of a varicocele. I felt well-versed from my reading and proudly regurgitated all I had learned about the anatomy of the left testicular vein and pampiniform plexus, incompetent or absent valves in the vein, increased testicular temperature, sluggish flow of blood from the left testis and possible toxins from the opposing left adrenal gland vein entering the dilated, incompetent testicular vein – any or all of which could contribute to disturb spermatogenesis and cause infertility. It all seemed simple enough! I pretty much thought we knew all we needed to know about this so-called “bag of worms.”
Topics: Humans; Male; Varicocele
PubMed: 26780874
DOI: 10.4103/1008-682X.172643 -
Journal of Vascular and Interventional... Jul 2022To conduct a systematic review and meta-analysis to assess the relative efficacy of endovascular and surgical treatments for varicocele. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To conduct a systematic review and meta-analysis to assess the relative efficacy of endovascular and surgical treatments for varicocele.
MATERIALS AND METHODS
PubMed and Embase databases were systematically searched to identify studies reporting on the outcomes associated with surgical or endovascular treatments of varicoceles. The studies that assessed the relative efficacy of surgical and endovascular treatments for patients with clinical varicocele were eligible for inclusion. Pooled data analyses were performed.
RESULTS
A total of 16 studies incorporating 2,138 patients were included in the present meta-analysis. The pooled risk ratio (RR) values suggested that rates of adverse events were lower among patients who underwent endovascular treatment than those who underwent surgical treatment (RR, 0.63; 95% confidence interval (CI), 0.42-0.93; P = .02). Both treatments were associated with similar rates of recurrence (RR, 1.03; 95% CI, 0.78-1.36; P = .82) and pregnancy (RR, 1.03; 95% CI, 0.85-1.25; P = .82).
CONCLUSIONS
These data demonstrate that endovascular treatment for varicocele is associated with similar rates of recurrence and subsequent pregnancy outcomes compared with surgical treatment but with lower rates of adverse events.
Topics: Female; Humans; Male; Pregnancy; Varicocele
PubMed: 35314371
DOI: 10.1016/j.jvir.2022.03.013 -
Fertility and Sterility Sep 2017Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. This paper reviews the indications for treatment of... (Review)
Review
Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. This paper reviews the indications for treatment of varicoceles, post-intervention outcomes following treatment, and the various techniques for treatment of varicoceles. The aim of this review is to describe and compare complications associated with each approach to varicocele treatment.
Topics: Combined Modality Therapy; Embolization, Therapeutic; Evidence-Based Medicine; Humans; Infertility, Male; Laparoscopy; Male; Treatment Outcome; Urogenital Surgical Procedures; Varicocele; Vascular Surgical Procedures
PubMed: 28865535
DOI: 10.1016/j.fertnstert.2017.07.020 -
Journal of Pediatric Urology Oct 2017The prevalence of varicoceles is as high as 15% in children and adolescents. Optimal management of varicoceles has not been consolidated. Options include observation,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The prevalence of varicoceles is as high as 15% in children and adolescents. Optimal management of varicoceles has not been consolidated. Options include observation, radiological intervention, or surgical varicocelectomy.
OBJECTIVE
Herein, we aim to assess the outcomes of radiological and surgical interventions for varicocele in children and adolescents evaluated by RCTs.
STUDY DESIGN
The study subjects were children and adolescents up to 21 years old, diagnosed with varicocele and allocated to receive either "surgical or radiological intervention" or "no treatment".
MATERIALS AND METHODS
We searched MEDLINE and EMBASE (Ovid platform), Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, Google Scholar, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform for RCTs reporting on varicocele treatment in children and adolescents up to June 23, 2016. Only RCTs with patients aged under 21 years were included. Main outcomes of interest included changes in testicular size, semen analysis parameters, surgical adverse events and failures.
RESULTS
Nine eligible studies were included in the systematic review. Meta-analysis based on available outcomes data demonstrated an improvement in testicular volume (mean difference 3.18 mL, 95% CI 1.94-4.42) and in sperm count (mean difference 25.54 × 10/mL, 95% CI 12.84-38.25) in patients who underwent radiological or surgical treatment compared with conservative management.
CONCLUSIONS
Based on current available randomized controlled trials, there is low to moderate level of evidence that radiological or surgical treatment of adolescent varicocele is associated with improved testicular size/growth and sperm concentration. The ultimate effects on fertility and paternity rates are not known.
Topics: Adolescent; Child; Humans; Male; Randomized Controlled Trials as Topic; Varicocele; Young Adult
PubMed: 28851509
DOI: 10.1016/j.jpurol.2017.07.008 -
Asian Journal of Andrology 2016In this review, we examine the evolution and application of various diagnostic modalities for varicoceles starting with venography, scintigraphy, and thermography and... (Review)
Review
In this review, we examine the evolution and application of various diagnostic modalities for varicoceles starting with venography, scintigraphy, and thermography and their role in the evaluation of a varicocele patient. Some of these methods have been supplanted by less invasive and more easily performed diagnostic modalities, especially ultrasound and Doppler examination of the scrotum. Advances in ultrasound and magnetic resonance imaging hold the potential to expand the role of imaging beyond that of visual confirmation and characterization of varicoceles. The ability to identify the early indicators of testicular dysfunction based on imaging findings may have implications for the management of varicoceles in the future.
Topics: Asymptomatic Diseases; Humans; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed; Ultrasonography; Varicocele
PubMed: 26780869
DOI: 10.4103/1008-682X.169991 -
Asian Journal of Andrology 2016In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain.... (Review)
Review
In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain. The surgical treatment of varicocele for hypogonadism is controversial and debated. Recently, multiple reports in the literature have suggested that varicocele is associated with hypogonadism and varicocele repair can increase testosterone levels. Men with hypogonadal symptoms should have at least two serum testosterone levels. Microsurgical varicocelectomy may be beneficial for men with clinically palpable varicoceles with documented hypogonadism. In this review, we summarize the most recent literature linking varicocele to hypogonadism and sexual dysfunction and the impact of repair on serum testosterone levels. We performed a search of the published English literature. The key words used were "varicocele and hypogonadism" and "varicocele surgery and testosterone." We included published studies after 1998. We, also, evaluated the effect of surgery on the changes in the serum testosterone level regardless of the indication for the varicocele repair.
Topics: Erectile Dysfunction; Humans; Hypogonadism; Male; Testosterone; Varicocele
PubMed: 26696437
DOI: 10.4103/1008-682X.169560 -
Drugs of Today (Barcelona, Spain : 1998) Jan 2002Varicocele is an extremely common entity, present in 15% of the male population. Varicoceles are found in approximately 35% of men with primary infertility but 75%-81%... (Review)
Review
Varicocele is an extremely common entity, present in 15% of the male population. Varicoceles are found in approximately 35% of men with primary infertility but 75%-81% of men with secondary infertility. Mounting evidence clearly demonstrates that varicocele causes progressive duration-dependent injury to the testis. Larger varicoceles appear to cause more damage than small varicoceles and, conversely, repair of large varicoceles results in greater improvement of semen quality. Varicocelectomy can halt the progressive duration-dependent decline in semen quality found in men with varicoceles. The earlier the age at which varicocele is repaired, the more likely is recovery of spermatogenic function. Varicocelectomy can also improve Leydig cell function resulting in increased testosterone levels. The most common complications after varicocelectomy are hydrocele formation, testicular artery injury and varicocele persistence or recurrence. The incidence of these complications can be reduced by employing microsurgical techniques, with inguinal or subinguinal operations, and exposure of the external spermatic and scrotal veins. Employment of these advanced techniques of varicocelectomy provide a safe, effective approach to elimination of varicocele, preservation of testicular function and, in a substantial number of men, an increase in semen quality and likelihood of pregnancy.
Topics: Animals; Humans; Male; Microsurgery; Testis; Varicocele; Vascular Surgical Procedures
PubMed: 12532185
DOI: 10.1358/dot.2002.38.1.677133 -
Asian Journal of Andrology 2016Varicoceles had been recognized in clinical practice for over a century. Originally, these procedures were utilized for the management of pain but, since 1952, the... (Review)
Review
Varicoceles had been recognized in clinical practice for over a century. Originally, these procedures were utilized for the management of pain but, since 1952, the repairs had been mostly for the treatment of male infertility. However, the diagnosis and treatment of varicoceles were controversial, because the pathophysiology was not clear, the entry criteria of the studies varied among centers, and there were few randomized clinical trials. Nevertheless, clinicians continued developing techniques for the correction of varicoceles, basic scientists continued investigations on the pathophysiology of varicoceles, and new outcome data from prospective randomized trials have appeared in the world's literature. Therefore, this special edition of the Asian Journal of Andrology was proposed to report much of the new information related to varicoceles and, as a specific part of this project, the present article was developed as a comprehensive review of the evolution and refinements of the corrective procedures.
Topics: History, 20th Century; Humans; Male; Microsurgery; Spermatic Cord; Varicocele
PubMed: 26732111
DOI: 10.4103/1008-682X.170866 -
Current Opinion in Urology Nov 2012This review looks at the literature on varicocele repair and its effect on assisted reproductive techniques. The effects of varicocele correction on improved sperm... (Review)
Review
PURPOSE OF REVIEW
This review looks at the literature on varicocele repair and its effect on assisted reproductive techniques. The effects of varicocele correction on improved sperm production have been well documented with semen analysis data. What remain to be elucidated are the causes of the varicocele effect and how correction of the resultant pathophysiology may affect the outcomes of modern assisted reproductive technology.
RECENT FINDINGS
Basic science research shows us that varicoceles exert deleterious effects on Leydig cells, Sertoli cells, and germ cells via very different mechanisms. The effects of varicocele correction on the reproductive potential of sperm are less well understood. Clinical research has shown improved semen parameters, DNA integrity, and assisted reproductive technology outcomes after varicocele repair.
SUMMARY
Varicocele correction presents a possible method to optimize a couples' reproductive potential or decrease the need for complex assisted reproductive technology.
Topics: Animals; DNA Damage; Fertility; Humans; Infertility, Male; Male; Reproductive Techniques, Assisted; Semen Analysis; Spermatogenesis; Spermatozoa; Testis; Treatment Outcome; Urologic Surgical Procedures, Male; Varicocele
PubMed: 23026896
DOI: 10.1097/MOU.0b013e328358e191 -
Balkan Medical Journal Apr 2020Varicocele might cause deterioration in Leydig cell functions, and it is a significant risk factor for hypogonadism. Some controversial issues have been raised in the... (Review)
Review
Varicocele might cause deterioration in Leydig cell functions, and it is a significant risk factor for hypogonadism. Some controversial issues have been raised in the treatment of hypogonadal men with varicoceles. Symptomatic hypogonadal men with varicoceles have two options: testosterone replacement therapy or varicocele treatment. Both approaches have some advantages and disadvantages. This review summarizes the effect of varicoceles on total plasma testosterone level and addresses whether varicocele repair is effective to improve testosterone levels in hypogonadal men with varicoceles. Experience from large clinical studies in the literature suggests that varicocele repair may increase serum testosterone level in men with varicoceles and testosterone deficiency. Varicocele repair could be offered to men with clinically palpable varicocele and hypogonadism. As the treatment method, microsurgical varicocele repair could be preferred to provide the best improvement. Another advantage of varicocele repair for hypogonadism, instead of exogenous testosterone treatment, is its ability to preserve the fertility status in men who may desire a child in the future. However, further studies are required to clarify varicocel-related Leydig cell dysfunction and to advise hypogonadal patients about the sufficient effectiveness of varicocele repair.
Topics: Humans; Hypogonadism; Male; Risk Factors; Testosterone; Varicocele
PubMed: 32070086
DOI: 10.4274/balkanmedj.galenos.2020.2020.1.85