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 treatment in adolescents: a randomized study.
OBJECTIVE To study the effects of varicocele treatment on  testicular function in adolescents . DESIGN A prospect i ve controlled study in 88 r and omly selected adolescents . SETTING All participants were referred to the fertility outpatient clinic of our university hospital . PARTICIPANTS All participants with a varicocele were r and omly assigned into two groups . Group 1 ( n = 33 ) was not treated , whereas group 2 ( n = 34 ) was treated . A similar group of healthy volunteers without a varicocele served as a control group ( group 3 , n = 21 ) . INTERVENTIONS  Testes volumes were measured at intake and during follow-up using an orchiometer .  Semen analysis was performed according to st and ard procedures both at intake and after 1 year of follow-up . Serum hormone levels were determined at intake using a radioimmunoassay . Treatment was performed by means of transcatheter embolization of the left testicular vein . MAIN OUTCOME MEASURES Testes volumes and semen quality at intake and after 1 year of follow-up were compared within and between the three groups . Hormonal parameters were determined at intake only . RESULTS Before treatment , the mean left testis volume in groups 1 ( n = 26 ) and 2 ( n = 27 ) ( 20.0 mL ; 95 % confidence interval [ CI ] : 18.2 to 21.8 and 21.6 mL ; 95 % CI : 19.4 to 23.8 , respectively ) were significantly smaller than those in the control group ( n = 19 ) ( 24.5 mL ; 95 % CI : 22.7 to 26.4 ) . During follow-up , left testis volumes of the treated group were comparable with those in the control group ( 24.2 mL ; 95 % CI : 22.2 to 26.1 and 24.8 mL ; 95 % CI : 23.0 to 26.7 respectively ) and significantly ( P < 0.001 ) different from the untreated group ( 20.3 mL ; 95 % CI : 18.8 to 21.8 ) . A significant increase in left ( P < 0.01 ) as well as right ( P < 0.05 ) testis volume was observed after treatment . Semen parameters before treatment were not significantly different between the three groups . Sperm concentration increased significantly ( P < 0.01 ) from 47.4 x 10(6)/mL ( 95 % CI : 42.5 to 53.3 ) to 68.9 x 10(6)/mL ( 95 % CI : 50.6 to 87.2 ) in the treated group , whereas semen quality in the untreated and control groups did not change . Although both testes volumes and sperm concentration improved in the treated group , these phenomena were not consistently correlated to each other . CONCLUSIONS Although not apparent in all adolescents , varicocele correction result ed in an increase in left testis volume and sperm concentration . At this moment , it is not clear if early preventive treatment of varicocele in adolescents , in time , will have a positive effect on testicular function
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 .