Taken together , the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy .
Abstract Despite being first described two thous and years ago , the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility , hypogonadism , and chronic orchidalgia .
The underlying mechanisms remain poorly understood and likely include hypoxia , oxidative stress , hyperthermia , anatomical aberrations , and genetics as primary components .
Despite a high prevalence amongst asymptomatic fertile men , varicoceles paradoxically also represent the most common correctable cause for male infertility .
In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations .
We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain .
Effects of varicocele on serum testosterone and changes of testosterone after varicocelectomy: a prospective controlled study.
OBJECTIVE To examine the hypotheses that clinical varicoceles affect baseline serum total testosterone levels ( T ) and varicocelectomy improves T. MATERIAL S AND METHODS This prospect i ve , nonr and omized , controlled study involved 4 groups of adult men . Varicocele-infertile treatment group ( VIT ) included 66 men who underwent varicocelectomy . Thirty-three varicocele-infertile control men ( VIC ) and 33 varicocele-fertile control men ( VFC ) were only observed . Normal-control ( NC ) group included 33 fertile men without varicocele . Varicocele groups were stratified into baseline hypogonadal ( T < 300 ng/dL ) or eugonadal ( T ≥300 ng/dL ) subgroups . Main outcome measurements were between-group baseline T differences ; and within-group T changes at 6- and 12-month follow-ups of men with varicocele . P < .05 was considered significant . RESULTS Means ( st and ard deviations ) of baseline T in VIT , VIC , VFC , and NC were 347.4 ( 132.1 ) , 339.7 ( 125.8 ) , 396.6 ( 164.9 ) , and 504.8 ( 149.7 ) ng/dL , respectively . The baseline T levels of varicocele groups were comparable , whereas they were significantly low compared with NC group . At 6-month follow-up , VIT demonstrated significant T improvements ( mean change = 44.7 ng/dL ; 12.9 % ; P < .0001 ) . T changes were more remarkable among baseline hypogonadals ( mean change = 93.7 ng/dL ; 40.1 % ; P < .0001 ) compared with eugonadals ( mean change = 8.6 ng/dL ; 2.01 % ; P = .1223 ) . These improvements were persistent at 12-month follow-up . Contrariwise , VIC and VFC exhibited nonsignificant T changes . Postvaricocelectomy T changes correlated significantly and inversely with baseline T ( r = -0.689 ; P < .0001 ) . This correlation was stronger and more significant among hypogonadals ( r = -0.528 ; P = .004 ) than eugonadals ( r = -0.400 ; P = .013 ) . T improvements also exhibited significant positive correlations with preoperative and postoperative sperm concentrations . CONCLUSION Baseline T was significantly low in men with varicocele compared with normal men . Varicocelectomy yielded significant T improvements among hypogonadal men but insignificant changes in eugonadals . T changes correlated strongly and significantly with baseline T and sperm concentrations
Taken together , the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy .
Abstract Despite being first described two thous and years ago , the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility , hypogonadism , and chronic orchidalgia .
The underlying mechanisms remain poorly understood and likely include hypoxia , oxidative stress , hyperthermia , anatomical aberrations , and genetics as primary components .
Despite a high prevalence amongst asymptomatic fertile men , varicoceles paradoxically also represent the most common correctable cause for male infertility .
In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations .
We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain .