Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction

Schlegel, Peter N.; Goldstein, Marc

doi:10.1016/j.fertnstert.2011.10.033

Cited by 74 publications

(48 citation statements)

References 54 publications

(40 reference statements)

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“…4 It is clear from both animal and human studies that varicocele impedes testosterone synthesis and androgen signaling at multiple levels. 8,15,34,61 In addition, it is now evident that varicocelectomy improves serum testosterone levels, with the largest benefit to those who have lower testosterone concentrations preoperatively.…”

Section: Varicocelectomy For Hypogonadism-clinical Significancementioning

confidence: 99%

“…However, a small subset of men will present with infertility, orchialgia, or ipsilateral testicular hypotrophy, which serve as common indications for varicocelectomy. 3,4 Traditionally, varicocele has been characterized by its impact on spermatogenesis via local effects on Sertoli and germ cells. It has become more evident, however, that varicocele presents a pantesticular insult.…”

Section: Introductionmentioning

confidence: 99%

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Testosterone and Varicocele

Hayden

Tanrikut

2016

Urologic Clinics of North America

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Section: Varicocelectomy For Hypogonadism-clinical Significancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Testosterone and Varicocele

Hayden

Tanrikut

2016

Urologic Clinics of North America

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“…Patients describe pain as heaviness or a dull ache, generally after prolonged ambulation, worsening with physical activity and straining. 3–5 The optimal technique for varicocelectomy is still a matter of controversy. Techniques include open surgical ligation of the spermatic vein, retrograde or anterograde sclerotherapy, microsurgery, and laparoscopy.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Varicocelectomy in the Management of Chronic Scrotal Pain

Kachrilas

Popov

Bourdoumis

et al. 2014

JSLS

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Background and Objectives:To evaluate the usefulness of laparoscopic varicocelectomy in the management of chronic scrotal pain.Methods:Between 2009 and 2011, 48 patients in total were treated with laparoscopic varicocelectomy for dull scrotal pain that worsened with physical activity and was attributed to varicoceles. All patients were followed up at 3 and 6 months and biannually thereafter with a physical examination, visual analog scale score, and ultrasonographic scan in selected cases.Results:The mean age was 38.2 years (range, 23–54 years). The mean follow-up period was 19.6 months (range, 6–26 months). Bilateral varicoceles were present in 7 patients (14.6%), and a unilateral varicocele was present in 41 (85.4%). The varicocele was grade 3 in 27 patients (56.3%), grade 2 in 20 (41.6%), and grade 1 in 1 (2.1%). The mean preoperative visual analog scale score was 4.8 on a scale from 0 to 10. The mean postoperative visual analog scale score at 3 months was 0.8. After the procedure, 42 patients (87.5%) had a significant improvement in the visual analog scale score (P < .001); 5 (10.4%) had symptom improvement, although it was not statistically significant; and 1 (2.1%) remained unchanged. During follow-up, we observed 5 recurrences (10.4%) whereas de novo hydrocele formation was identified in 4 individuals (8.3%).Conclusion:Laparoscopic varicocelectomy is efficient in the treatment of symptomatic varicoceles with a low complication rate. However, careful patient selection is necessary because it appears that individuals presenting with sharp, radiating testicular pain and/or a low-grade varicocele are less likely to benefit from this procedure.

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“…However, most of the existing data agree that varicocele repair increases natural pregnancy rates and mitigates the need for multiple assisted reproductive technology cycles[87-89]. Recently, there is increased evidence that clinically significant varicocele may influence testosterone production, and some researchers advocate varicocele repair in cases of decreased testosterone levels, including patients with non-obstructive azoospermia[90-92]. …”

Section: Treatmentmentioning

confidence: 99%

Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele

Tsili

Xiropotamou

Sylakos

et al. 2017

WJR

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Varicocele is characterized by an abnormal dilatation and retrograde blood flow in the spermatic veins. Varicocele is the leading correctable cause of male infertility. Although it is highly prevalent in infertile men, it is also observed in individuals with normal fertility. Determining which men are negatively affected by varicocele would enable clinicians to better select those men who will benefit from treatment. To assess the functional status of the testes in men with varicocele, color Doppler sonographic parameters were evaluated. Testicular arterial blood flow was significantly reduced in men with varicocele, reflecting an impairment of spermatogenesis. An improvement in the testicular blood supply was found after varicocelectomy on spectral Doppler analysis. Testicular contrast harmonic imaging and elastography might improve our knowledge about the influence of varicocele on intratesticular microcirculation and tissue stiffness, respectively, providing possible information on the early damage of testicular structure by varicocele. Magnetic resonance imaging (MRI), with measurement of apparent diffusion coefficient has been used to assess the degree of testicular dysfunction and to evaluate the effectiveness of varicocele repair. Large prospective studies are needed to validate the possible role of functional sonography and MRI in the assessment of early defects of spermatogenesis in testes with varicocele.

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Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction

Cited by 74 publications

References 54 publications

Testosterone and Varicocele

Testosterone and Varicocele

Laparoscopic Varicocelectomy in the Management of Chronic Scrotal Pain

Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele

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