Surgical treatment of varicocele by a subinguinal approach combined with antegrade intraoperative sclerotherapy of venous vessels

Colpi, Giovanni M.; Carmignani, Luca; Nerva, Franco; Piediferro, G.; Castiglioni, Fabrizio; Grugnetti, C.; Galasso, Giacomo

doi:10.1111/j.1464-410x.2006.05915.x

Cited by 31 publications

(28 citation statements)

References 18 publications

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“…The mean intervals from surgery to improvement in semen parameters and to spontaneous pregnancy were reported to be approximately 5 and 7 months, respectively [59]. However, a recent study at Kobe University reported earlier improvement in sperm DNA integrity after microsurgical repair of varicoceles [60].…”

Section: New Role Of Varicocele Repair In the Art Eramentioning

confidence: 99%

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Kimura

Nagao

2014

Reprod Medicine & Biology

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Varicocele is an abnormal condition characterized by dilatation of the pampiniform plexus veins draining the testis and is present in 15 % of men. Varicoceles have an adverse effect on spermatogenesis and are the most common cause of male infertility. Approximately 35 % of infertile men and more than 70 % of men with secondary infertility were reported to have varicoceles. Although data on methods of varicocele repair are accumulating, there remains controversy regarding the indications and techniques for varicocele repair. In addition, the role of varicocele repair in this era of assisted reproductive technologies continues to be debated. In this study, we performed a comprehensive PubMed search in order to review the current status of varicocele repair for male infertility. We reviewed English-language studies published from 1992 through 2013. After reviewing the articles, we identified a recent meta-analysis of four randomized controlled trials, which found that varicocele repair for oligozoospermic men was associated with better pregnancy rates as compared with observation. Our review of prospective studies showed that all semen parameters, including sperm concentration, motility, and progressive motility, were significantly improved after varicocele repair. We also summarize the findings of recent studies reporting beneficial effects of varicocele repair, i.e., decreased oxidative stress and sperm DNA fragmentation after varicocele repair and superior cost effectiveness versus in vitro fertilization/intracytoplasmic sperm injection alone, which may be important in the era of assisted reproductive technologies. Varicocele repair is a widespread, well-established procedure that can improve semen parameters in men with infertility. The effect of such treatment on the pregnancy rate is unclear because evidence is limited due to difficulties in recruiting patients for studies. Among the repair techniques, microsurgical repair using a subinguinal approach is potentially the best practice, although this procedure requires training in microsurgery. All these topics require further research in studies with sufficient patient enrollment and follow-up.

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Section: New Role Of Varicocele Repair In the Art Eramentioning

confidence: 99%

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Kimura

Nagao

2014

Reprod Medicine & Biology

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“…From April 2004 to September 2005, we diagnosed 25 cases of left varicocele with concomitant testicular hypotrophy; published reports suggest that a difference of 1 25% of testicular volume is considered as testicular hypotrophy [5] . The mean age of the patients was 14.4 years.…”

Section: Methodsmentioning

confidence: 99%

Sclerotherapy of the Pampiniform Plexus with Modified Marmar Technique in Children and Adolescents

et al. 2009

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Aims: Treatment of varicocele in children is a debated problem for which no validated guidelines exist. Several techniques have been proposed to solve this problem. The aim of this study was to evaluate the effectiveness and applicability of a modified Marmar technique in the treatment of varicocele in children and adolescents. Methods:From April 2004 to September 2005, we evaluated 25 patients between the ages of 9 and 18 (mean 14.4) years, who suffered from left-sided varicocele with concomitant testicular hypotrophy. The diagnosis was ascertained clinically and with scrotal color Doppler ultrasound using the Dubin and Amelar classification. In 2 cases phimosis was also present. The operation was performed according to a modified Marmar technique, using embolization of the pampiniform plexus with 2 ml of 3% polidocanol. Patients underwent clinical evaluation and scrotal color Doppler ultrasound at 1 week and 3 and 6 months. Results: The mean duration of the operation was 42 min. At 1 week after surgery no persistence of varicocele was found. In 1 patient, edema of the spermatic cord occurred for about 2 months with spontaneous regression, in 1 patient homolateral hydrocele was observed. At 6 months no other complications were reported. No case of testicular atrophy was observed. Conclusions: The technique described has already been validated in the adult population, and although we present only a small number of cases, the operation proved easy to perform, safe, of low cost and can be considered a valid alternative to the microsurgical technique in children and adolescents.

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“…Duration and severity of varicocele may be a risk factor for infertility related with age in patients with varicocele (7). The mean time for semen improvement and spontaneous pregnancy after surgery is approximately five to seven months, respectively (8). However, the aetiology of underlying infertility is especially uncertain in men whose semen parameters do not significantly improve or do not achieve pregnancy following varicocele surgery.…”

Section: Introductionmentioning

confidence: 99%

Does the duration of infertility affect semen parameters and pregnancy rate after varicocelectomy?: a retrospective study

et al. 2011

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Objectives:The most common indication for treatment of varicocele is still male subfertility. The aim of this study was to explore the effect of infertility duration on semen parameters and spontaneous pregnancy rate after varicocelectomy. Materials and Methods:The medical records of 183 infertile patients with clinical varicocele were retrospectively reviewed. The patients were divided into three groups according to the duration of infertility (group I, 1-3 years, group II, 3-6 years and group III, > 6 years). Total sperm motility counts (TMCs) before and after varicocelectomy and spontaneous pregnancy rate among these groups were statistically compared. Results: The greatest changes, regarding preoperative and postoperative TMCs and spontaneous pregnancy rate were noticed between group I and III. Preoperative TMCs in group I and III was 15.2 ± 1.2, 7.8 ± 1.4, respectively (p < 0.05). Postoperative TMCs in group I and III was 33.7 ± 2.5, 25.2 ± 1.9, respectively (p < 0.05). An overall spontaneous pregnancy rate of 34.4% was achieved after inguinal varicocelectomy. The greatest spontaneous pregnancy rate was achieved in Group I (37.3%), and the lowest pregnancy rate in Group III (26.3%) (P < 0.05). Conclusions: Surgical varicocelectomy improves the total sperm motility counts especially in patients who have a TMCS more than 5 million and improves the spontaneous pregnancy rates. The improvement in the spontaneous pregnancy rates after varicocelectomy correlates negatively with the duration of infertility. Therefore, duration of infertility should be considered in treating a patient with a varicocele as a cause of infertility.

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Surgical treatment of varicocele by a subinguinal approach combined with antegrade intraoperative sclerotherapy of venous vessels

Cited by 31 publications

References 18 publications

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Sclerotherapy of the Pampiniform Plexus with Modified Marmar Technique in Children and Adolescents

Does the duration of infertility affect semen parameters and pregnancy rate after varicocelectomy?: a retrospective study

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