[Treatment of varicoceles]

The mechanisms of infertility in varicoceles are still ill-defined; their repercussions are variable and unrelated to the degree of venous dilatations (a good number of such patients have no fertility problems). Oligo-astheno-teratospermia is a non-pathognomonic entity, also encountered in chronic infections, previous history of cryptorchidism, gonadotrophic insufficiencies and toxic of iatrogenic causes. Should varicoceles be operated on, in order to treat the oligo-astheno-teratospermia? After strongly advocating surgery in the 60's, this approach is, in retrospect, being questioned. Varicoceles affect a very heterogeneous population with various degrees of infertility. To answer this question, randomized studies based on strict criteria, should be undertaken.