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 .
Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: Prospective comparison of reproductive and functional outcomes
Background Varicocele is a condition characterized by dilated , tortuous veins within the pampiniform venous plexus of the scrotal sac . Presence of varicocele is associated with an increased risk of alteration of semen parameters . The objective of this study was to compare the current st and ard in varicocele treatment procedures : sub-inguinal microscopic ligation to percutaneous embolization in terms of semen parameters improvement , fertility , and morbidity at the university hospital of Toulouse ( France ) . Seventy six patients with clinical varicocele , alteration of semen parameters and infertility , underwent either procedure ( microsurgery in 49 case performed by a single surgeon and embolization in 27 cases ) and were prospect ively analyzed . Outcome measures were : semen parameters , spontaneous pregnancies , pain , side effects , recovery time and overall satisfaction . All patients were contacted in January 2015 in order to determine reproductive events . Results Preoperatively , there was no difference in clinical and biological items between the two groups . Postoperatively , on the overall population , there was a significant improvement of sperm concentration at 3 , 6 , 9 and 12 months ( p = < 0.001 , < 0.001 , 0.012 , 0.018 ) and sperm motility at 6 months ( p = 0.002 ) . The sperm concentration was higher at 6 months in the percutaneous embolization group ( 13.42 , vs. 8.1 × 106/ml ; p = 0.043 ) . With a median follow-up of 4 years , 27 pregnancies occurred ( spontaneous pregnancy rate of 35.5%).There was no significant difference between procedures on the sperm quality , pregnancy rate , and the overall satisfaction . Patients undergoing percutaneous embolization reported a faster recovery time ( p = 0.002 ) and less postoperative pain ( p = 0.007 ) . Conclusion Our study shows that percutaneous embolization seems to be an equivalent alternative to sub-inguinal microscopic ligation in term of sperm quality improvement , pregnancy rate , and overall satisfaction with a slight advantage on post-operative morbidity . Résumé Context eLa varicocèle est une affection caractérisée par une dilatation et tortuosité des veines du plexus veineux pampiniforme du sac scrotal . La présence de varicocèle est associée à un risque accru d'altération des paramètres du sperme . Cette étude vise à comparer la norme actuelle des procédures de traitement par varicocèle : la ligature microscopique sous-inguinale à l'embolisation percutanée en termes d'amélioration des paramètres spermatiques , de fertilité et de morbidité dans l'hôpital universitaire de Toulouse(France ) . Soixante-seize patients atteints de varicocèle clinique , d'altération des paramètres spermatiques et d'infertilité ont subi une intervention  ( microchirurgie dans 49 cas réalisées par un seul urologue et embolisation dans 27 cas ) et ont fait l'objet d'une analyse prospect i ve . Les données étudiées sont les suivantes : paramètres du sperme , grossesses spontanées , douleur , effets secondaires , temps de récupération et satisfaction globale . Tous les patients ont été contactés en janvier 2015 afin de déterminer les grossesses spontanées . RésultatsEn préopératoire , il n’existait aucune différence sur les items cliniques et biologiques entre les deux groupes . Sur la population globale , on observe une amélioration significative de la concentration spermatique à 3 , 6 , 9 et 12 mois ( p = < 0,001 , < 0,001 , 0,012 , 0,018 ) et de la motilité à 6 mois ( p = 0,002 ) . La concentration de spermatozoïdes était plus élevée à 6 mois dans le groupe d'embolisation percutané ( 13,42 vs 8,09 ; p = 0,043 ) . Avec un suivi médian de 4 ans , 27 grossesses sont survenues ( taux de grossesse spontanée de 35.5%).Il n'y avait pas de différence significative entre les procédures sur la qualité du sperme , le taux de grossesse et la satisfaction globale . Les patients traités par embolisation percutanée ont rapporté un temps de récupération plus rapide ( p = 0,002 ) et moins de douleur postopératoire ( p = 0,007 ) . Conclusion Notre étude montre que l'embolisation percutanée semble être une alternative équivalente à la ligature microscopique sous-inguinale en terme d'amélioration de la qualité du sperme , du taux de grossesse et de la satisfaction globale avec un léger avantage sur la morbidité post-opératoire
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 .