Prevention of Fertility Disorders by Detection and Treatment of Varicocele at School and College Age

Steeno, Omer; Knops, Jacquelina; Declerck, Léa; Adimoelja, A; Voorde, Herman Van de

doi:10.1111/j.1439-0272.1976.tb01645.x

Cited by 238 publications

(58 citation statements)

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“…Varicoceles affect 15 % of adolescent males, similar to the incidence reported in healthy adult men [3]. The major concern for patients with a varicocele is infertility; with a varicocele present in 25-69 % of adults evaluated for infertility [4,5].…”

Section: Introductionmentioning

confidence: 82%

The dilemma of adolescent varicocele

Garcia-Roig

Kirsch

2015

Pediatr Surg Int

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Adolescent varicocele is associated with ipsilateral testicular hypotrophy and the concern for future infertility. A testicular size discrepancy greater than 15-20 % between left and right testicle is an indication for treatment to allow catch-up growth in the hope of preventing a future decline in fertility. Some authors advocate for a period of watchful waiting, as normal testicular growth may occur asymmetrically. We review the current literature to highlight some controversies and challenges in management.

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Section: Introductionmentioning

confidence: 82%

The dilemma of adolescent varicocele

Garcia-Roig

Kirsch

2015

Pediatr Surg Int

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“…Scrotal varicocoeles commonly appear in early puberty during the growth spurt (Preston et al, 2008). These ectatic and tortuous veins of the pampiniform plexus are found in ca 12-15% of male adolescents, with a marked left-sided predominance of 90% (Steeno et al, 1976). Varicocoeles are rarely evident before early adolescence clinically.…”

Section: Introductionmentioning

confidence: 99%

“…Varicocoeles are rarely evident before early adolescence clinically. However, it is believed that the population of boys with varicocoeles represents the same population of adults with varicocoeles (Steeno et al, 1976). Although varicocoeles appear during adolescence, the pathophysiology of varicocoele remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

Adolescent varicocoele management controversies

2012

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SUMMARYVaricocoele is defined as excessive dilatation of the pampiniform venous plexus of the spermatic cord. Varicocoele frequently appears during early puberty and is recognized to be the most common surgically correctable cause of male infertility. However, the actual incidence in adolescents, pathophysiology and the association with male factor infertility all remain somewhat controversial. The most accurate diagnostic technique for identifying young men who will benefit from surgical treatment has yet to be established. Observations of testicular asymmetry and deteriorating semen quality helped establish current guidelines and recommendations for surgical treatment. Further studies, comparing observation with surgical intervention, are needed to refine the current indications for varicocoele repair in the adolescent male.

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“…5,6 Varicocele has been shown not to begin at adulthood, but more likely at adolescence or childhood. Two large studies by Oster 7 and Steeno et al 8 showed the incidence of varicoceles before adulthood at 16.2% and 14.7%, respectively. The term varicocele refers to varicose veins affecting the testicle, when the valves of the veins are incompetent and leaking with backflow.…”

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confidence: 98%

Laparoscopic Varicocelectomy: My Personal Experience of 4000 Cases

Chen

2016

International Surgery

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Varicocele accounts for 40% of male infertility. Laparoscopic varicocelectomy was used for the treatment of a series of 4000 men. The operation was a high bilateral ligation. The average time for the operation was 1 hour and 15 minutes. There were no complications and patients were discharged on the same day of the operation. Testicular damage from varicocele was permanent, and the usual percentage was 10% of total testicular tissue examined. The surgery was very well accepted by patients. Semen parameters improved among 80% of the patients, with 45% of their wives becoming pregnant. There is clearly a role for video laparoscopic varicocelectomy in the treatment of male infertility.Key words: Varicocele -Laparoscopic varicocelectomy -Male infertility -Abnormal semen I t is common knowledge that fertility is declining worldwide, with a rate of 25% among couples 1,2 ; of that number, the male contribution is conservatively at approximately 45%.3 While there are multiple causes in the male, one major cause is varicocele, which now cannot be ignored or even brushed off as controversial. In fact, both the American Society for Reproductive Medicine and the American Urological Association have found that varicocele causes infertility. 4 The incidence of varicocele can vary between 19% and 41% (the incidence is more reflective to that of 41%). 5,6 Varicocele has been shown not to begin at adulthood, but more likely at adolescence or 9 As a result of leakage, there is a backflow of renal blood down these veins. This renal reflux results in toxic damage to both spermatogenesis and male hormone production by the Leydig cell. 10Consequently, the testes are damaged in varying progressive stages over time. There is hyperthermia, testicular shrinkage and atrophy, sperm membrane damage, chromosomal breaks, spermatogenic arrest, maturation arrest, Sertoli cell destruction, and germinal epithelial sloughing. Male hormone production also declines, which affects health, and accelerates andropause. In its earlier subclinical stages, varicocele is diagnosed by Doppler ultrasound, whereas in its later more advanced clinical stages, the swollen veins become palpable. The condition is bilateral, but may appear to manifest unilaterally.When medically indicated for clinically significant varicoceles, many treatment options have been used over time.11 On the whole, the treatment for the varicocele is surgical by occlusion of the testicular veins. The previous common approach is the inguinal route, but there is a 40% recurrence rate. 12Scrotal varicocelectomy is not practiced because of its poor smaller vessels and poor results. Thus, a high peritoneal varicocelectomy approach through the abdomen is more effective because there are fewer and larger varicose veins. 13,14 Methods PatientsThis study involved 4000 laparoscopic varicocelectomies for infertility from 1995 15 to 2015. Their ages ranged from 26 and 68 years. The majority were in the age group of 30 to 34 years, with a 3-year history of infertility. These men had semen analysis. Ind...

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Prevention of Fertility Disorders by Detection and Treatment of Varicocele at School and College Age

Cited by 238 publications

References 9 publications

The dilemma of adolescent varicocele

The dilemma of adolescent varicocele

Adolescent varicocoele management controversies

Laparoscopic Varicocelectomy: My Personal Experience of 4000 Cases

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