Treating varicocele in 2018: current knowledge and treatment options

Area of Science:

• Urology
• Reproductive Medicine
• Andrology

Background:

• Varicocele involves enlarged veins in the scrotum, affecting 5-20% of males.
• It is linked to infertility and reduced sperm quality due to impaired blood flow.
• This review examines varicocele's pathophysiology, clinical presentation, and treatment efficacy.

Purpose of the Study:

• To review the pathophysiology and clinical aspects of varicocele.
• To analyze therapeutic options and their impact on sperm parameters and fertility.
• To assess treatment outcomes in both adult and pediatric/adolescent populations.

Main Methods:

• Conducted a comprehensive literature search of Medline and PubMed (1965-2018).
• Utilized keywords including "varicocele," "varicocelectomy," "sclerotherapy," "male infertility," "subfertility," and "semen abnormalities."
• Focused on publications detailing clinical aspects, treatment procedures, and outcomes.

Main Results:

• Varicocele correction, via surgical or percutaneous methods, enhances semen parameters in most patients.
• Treatment effectively reduces oxidative stress and improves sperm nuclear DNA integrity.
• Positive outcomes are observed in both adolescent and adult males.

Conclusions:

• Varicocele repair is a cost-effective treatment for clinical varicocele with testicular hypotrophy, altered sperm, or infertility.
• The role of varicocelectomy is debated in the context of assisted reproductive technologies.
• Further research into varicocele's pathophysiology is crucial for understanding its effects on spermatogenesis and developing new treatments.