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Varicocele.

J L Pryor, S S Howards

    The Urologic Clinics of North America
    |August 1, 1987
    PubMed
    Summary
    This summary is machine-generated.

    Varicocele affects one-third of infertile men, potentially due to anatomical factors and elevated testicular temperature. Clinical examination is key for diagnosis, with surgical ligation remaining the preferred treatment, though percutaneous options exist for recurrent cases.

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    Area of Science:

    • Urology
    • Reproductive Medicine
    • Male Infertility

    Background:

    • Varicocele is diagnosed in approximately one-third of infertile men, significantly higher than the 15% incidence in the general male population.
    • Potential etiologies include anatomical variations like a longer left spermatic vein or absent valves, leading to increased hydrostatic pressure and dilatation, as well as the nutcracker phenomenon.
    • The pathophysiology, particularly the role of elevated intratesticular temperature due to increased blood flow, requires further investigation.

    Purpose of the Study:

    • To review the current understanding of varicocele etiology, pathophysiology, diagnosis, and treatment.
    • To evaluate the significance of subclinical varicoceles and the diagnostic utility of clinical examination.
    • To discuss treatment options for varicocele in both adult and adolescent populations.

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    Main Methods:

    • Review of existing literature on varicocele.
    • Emphasis on clinical examination as the primary diagnostic tool.
    • Comparison of surgical ligation and percutaneous treatment methods.

    Main Results:

    • Clinical examination is considered the most reliable diagnostic method for varicocele.
    • Adolescents with varicocele warrant treatment if testicular mass is reduced or symptoms are present.
    • Surgical ligation is the primary treatment; percutaneous treatment has a 73% occlusion rate and 5% recurrence rate, reserved for recurrent cases.

    Conclusions:

    • Varicocele diagnosis relies heavily on clinical examination.
    • Surgical ligation remains the gold standard for varicocele treatment.
    • Percutaneous treatment is a viable option for recurrent varicoceles, with a low complication rate.