Varicocele – a case for early intervention

Phil V Bach,Marc Goldstein,Bobby B Najari

doi:10.12688/f1000research.7179.1

Abstract

Testicular varicocele, which is defined as the dilation of the veins draining the testicle, has long been associated with a detrimental effect on testicular function. Despite a lack of high-quality, prospective data, recent evidence has shed light on potential links between varicocele and male infertility and serum testosterone levels. Similarly, varicocele repair has increasingly been shown to have a beneficial impact on pregnancy rates, semen parameters, and on improving serum testosterone in adult men. Numerous studies have assessed the optimal technique for varicocele repair and the bulk of the evidence has shown the microsurgical inguinal/subinguinal approach to have the highest success rates, the lowest overall complication rates, and the lowest recurrence rates. The management of varicocele in adolescents remains a clinical conundrum, but contemporary evidence suggests early deleterious effects of varicocele on testicular function in some patients. Well-designed prospective trials are critical to delineate the true impact and role of varicocele repair on male infertility and hypogonadism in adult and adolescent men.

Highlights

Testicular varicocele, which is defined as the dilation of the veins draining the testicle, occurs in approximately 15% of men in the general population[1]
Varicoceles have been associated with a progressive, detrimental effect on testicular function, affecting both spermatogenesis and Leydig cell function
A subgroup analysis performed by the same group of five randomized controlled trial (RCT) restricted to 505 men with clinical varicoceles, abnormal semen parameters, and pregnancy rate as the primary outcome significantly favored varicocele treatment

Summary

Introduction

Testicular varicocele, which is defined as the dilation of the veins draining the testicle, occurs in approximately 15% of men in the general population[1]. The results of the latest Cochrane subgroup analysis mirror a 2007 meta-analysis that included two RCTs and three observational studies of infertile men with clinical varicoceles, abnormal semen parameters, and spontaneous pregnancy as the primary outcome. While the current flawed evidence suggests that varicocele repair may be beneficial for men with infertility or hypogonadism, we echo numerous authors in calling for well-designed, prospective clinical trials that can provide confirmatory answers to the longstanding questions surrounding the impact and role for varicocele repair in the management of men with infertility or hypogonadism At this point, the ideal RCT looking at the impact of varicocele repair in adult men would be multi-institutional and compare microsurgical, testicular artery-sparing varicocele repair to nonintervention, with semen analyses, serum testosterone testing, and hypogonadism symptom assessments done according to the validated criteria and methodologies established in the literature. Adolescents with clinical varicocele at various centers that routinely either treat or do not treat varicocele would have their semen analyses, hormone levels, and reproductive outcomes followed prospectively through to adulthood using validated criteria and methodologies to assess semen analysis and serum testosterone

Conclusion

Sigman M

28. World Health Organization

Findings

43. Oster J