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[Pathogenesis and therapy of varicocele (author's transl)]
Insights
Varicocele surgery improved sperm quality in 174 of 209 patients, leading to 40 successful pregnancies. Recurrent varicoceles were treated by identifying overlooked venous branches, best visualized with preoperative phlebography.
Area of Science:
- Urology
- Andrology
- Reproductive Medicine
Background:
- Varicocele is a common cause of male infertility.
- Surgical intervention aims to improve semen parameters and fertility outcomes.
Purpose of the Study:
- To evaluate the efficacy of varicocele surgery on semen quality and fertility.
- To analyze the causes and management of recurrent varicoceles.
Main Methods:
- Retrospective analysis of 519 patients undergoing varicocele surgery over 13 years.
- Post-operative spermiogram analysis and fertility assessment in 209 cases.
- Preoperative phlebography for surgical planning in recurrent cases.
Main Results:
- 174 out of 209 (83.2%) patients showed improved spermiogram post-surgery.
- 40 children were fathered by patients with improved semen parameters.
- 18 patients required repeat surgery for recurrent varicocele, often due to overlooked venous collaterals.
Conclusions:
- Varicocele surgery is effective in improving semen quality and achieving fertility.
- Preoperative phlebography is crucial for identifying complex venous anatomy in recurrent varicocele cases, optimizing surgical planning.
Abstract:
During the last 13 years 519 patients were operated upon for varicocele in the refertilisation center Hamburg. Out of 209 cases examined thereafter, 174 showed an improved spermiogram, and only in this group 40 children were fathered. Pathogenesis, diagnosis and surgical treatment are presented. A persisting varicocele (in our clientele in 1 per cent) was corrected in 18 patients. The reasons for recurrent surgery were overlooked branches of the V. spermatica interna and not yet described collaterals to neighbouring venous systems. For optimal surgical planning the latter are best demonstrated by preoperative phlebography.