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 .
Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination.
OBJECTIVES Color Doppler ultrasound ( CDU ) diagnostic criteria for varicoceles are poorly defined , and the role of CDU in diagnosing varicoceles is controversial . The purpose of this study is to assess the diagnostic accuracy of CDU for varicoceles compared to physical examination . METHODS We prospect ively studied 64 patients with CDU and collected the following data :  maximum diameter of scrotal veins , the presence of a venous plexus , sum of the diameter of up to six veins of the plexus , and the duration and amplitude of flow change on Valsalva maneuver . To avoid interphysician variation , all patients were examined by one design ated senior urologist with the sonographer remaining unaware of the findings . RESULTS  CDU parameters of 127 testis units in 64 patients were analyzed and compared to the physical findings . Fifty-nine testis units were positive and 57 units were negative for varicocele on physical examination . In 11 testis units , results of physical examination were inconclusive regarding the presence of varicocele . The commonly accepted CDU criterion for varicocele ( maximal vein diameter of 3 mm or greater ) had a sensitivity of 53 % and specificity of 91 % compared to physical examination . We developed a new scoring system incorporating the maximal venous diameter ( score 0 to 3 ) , the presence of a venous plexus and the sum of the diameters of veins in the plexus ( score 0 to 3 ) , and the change of flow on Valsalva maneuver ( score 0 to 3 ) . Using a total score of 4 or more to define the presence of  CDU-positive varicocele , we observed a sensitivity of 93 % and a specificity of 85 % when compared to physical examination . All moderate to large varicoceles found on physical examination were positive by CDU diagnosis using the scoring system , but the same group had only a 68 % positive rate by traditional CDU diagnostic criteria . CONCLUSIONS Using the proposed new scoring system , CDU has been shown to be a reliable and accurate method of diagnosis for varicoceles compared to the current reference st and ard physical examination . CDU has the advantages of being able to objective ly examine venous plexus and measure blood flow parameters and to be less observer-dependent than physical examination
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 .