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 .
Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles.
PURPOSE The left varicocele is usually larger in men with bilateral varicoceles . We hypothesized that most of the benefit of varicocelectomy would derive from repair of the larger varicocele . To test this hypothesis we prospect ively compared the effect of unilateral versus bilateral microsurgical varicocelectomy in men with large ( grade III ) or moderate ( II ) left varicocele associated with small but palpable ( I ) right varicocele . MATERIAL S AND METHODS A total of 91 patients were prospect ively followed and included in the study . Of the patients 65 underwent bilateral and 26 underwent unilateral left repair . All patients underwent preoperative and postoperative semen analysis . RESULTS Motile sperm concentration increased from 12.1+/-1.7 to 23.7+/-31.8 ( 95.8 % change ) in the bilateral group compared with an increase from 19.5+/-21.4 to 27.8+/-34.8 ( 42.6 % change ) in the unilateral group ( p<0.05 ) . Similarly , sperm concentration increased from 23.8+/-29.5 to 48.6+/-61.3 ( 157.6 % change ) in the bilateral group compared with an increase from 41.1+/-40.9 to 59.5+/-66.7 ( 44.8 % change ) in the unilateral group ( p<0.05 ) . CONCLUSIONS Bilateral varicocelectomy result ed in significantly greater improvement in post-operative seminal parameters than unilateral repair in patients with grade s II to III left varicocele associated with grade I right varicocele . Even a small , unrepaired palpable right varicocele continues to have a detrimental effect on bilateral testis function . Men with bilateral palpable varicoceles require bilateral repair
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 .