Treating varicocele in 2018: current knowledge and treatment options

Purpose Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated...

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Bibliographic Details
Published in:Journal of endocrinological investigation 2018-12, Vol.41 (12), p.1365-1375
Main Authors: Zavattaro, M., Ceruti, C., Motta, G., Allasia, S., Marinelli, L., Di Bisceglie, C., Tagliabue, M. P., Sibona, M., Rolle, L., Lanfranco, F.
Format: Article
Language:English
Subjects:
Blood flow
Clinical aspects
Deoxyribonucleic acid
DNA
Endocrinology
Fertility
Health Knowledge, Attitudes, Practice
Humans
Infertility
Infertility, Male - etiology
Male
Males
Medicine
Medicine & Public Health
Metabolic Diseases
Oxidative stress
Review
Semen
Sperm
Spermatogenesis
Treatment Outcome
Varicocele - complications
Varicocele - surgery
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Summary:Purpose Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. Methods We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: “varicocele”, “varicocelectomy”, “sclerotherapy”, “male infertility”, “subfertility”, and “semen abnormalities”. Results Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. Conclusions Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.
ISSN:1720-8386
0391-4097
1720-8386
DOI:10.1007/s40618-018-0952-7