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 .
Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital.
PURPOSE We review the long-term results of varicocele repair , and compare the complication rates of varicocelectomy techniques according to optical magnification use in adolescents with varicocele at a single university hospital . MATERIAL S AND METHODS We prospect ively studied 100 males 7 to 19 years old with clinical palpable varicocele . Of the patients 52 ( 52 % ) underwent left unilateral varicocelectomy  and 48 ( 48 % ) underwent bilateral varicocelectomy . Varicocelectomy was performed using a microscope in 49 patients ( 79 sites ) , loupe magnification in 25 ( 35 sites ) and no magnification in 26 ( 34 sites ) using either a subinguinal or inguinal approach . Postoperative complications were compared in all patients based on technique . Preoperative and postoperative serum hormone values and semen parameters were compared in 33 patients . RESULTS Mean postoperative followup was 30.4 + /- 13.06 months ( 12 to 65 ) . Total motile sperm count increased from 22.6 million + /- 5.16 million to 64.53 million + /- 12.3 million postoperatively , which was statistically significant ( p = 0.002 ) . Postoperative recurrence rates were 0 % in cases managed by microsurgical varicocelectomy , 2.9 % in those where loupe magnification was used and 8.8 % in those where no magnification was used . Postoperative hydrocele rates in these cases were 0 % , 2.9 % and 5.9 % , respectively . The highest rates of recurrence and hydrocele were observed in cases where no magnification was used , compared to those managed by microsurgery ( p = 0.03 and p = 0.116 , respectively ) . CONCLUSIONS Adolescent varicocele repair improves semen parameters and is a safe method with low recurrence and low complication rates . Our study suggests that the postoperative complication rate significantly decreases with use of higher magnification , such as microscopy . Microsurgical varicocele repair is the best technique with the lowest postoperative rates of recurrence and hydrocele in the treatment of adolescent varicoceles
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 .