Varicocele and Male Subfertility: Prognostical Criteria in the Surgical Treatment

Menchini-Fabris, G. F.; Canale, Domenico; C, Basile-Fasolo; Coscio, M Di; Izzo, Pier Luigi; Giannotti, P; Marino, Paloma de; Servadio, L; Baldassari, S; Fratta, M

doi:10.1111/j.1439-0272.1985.tb00953.x

“…In addition, interventional failure with the radiologic approach and major complications with the laparoscopic approach were reviewed. To compare spontaneous pregnancy rates among the techniques used for varicocele repair, the approaches in this review included retroperitoneal high ligation (Palomo technique) with 10 studies (Cockett et al, 1984; Baker et al, 1985; Menchini‐Fabris et al, 1985; Rageth et al, 1992; Hirokawa et al, 1993; Nieschlag et al, 1993; Madgar et al, 1995; Shlansky‐Goldberg et al, 1997; Çayan et al, 2000; Watanabe et al, 2005), microsurgical subinguinal or inguinal technique with 12 studies (subinguinal, 7; inguinal, 5; 1 study to compare both approaches; Goldstein et al, 1992; Ito et al, 1993; Marmar and Kim, 1994; Çayan et al, 2000, 2002; Jungwirth et al, 2001; Kamal et al, 2001; Perimenis et al, 2001; Kumar and Gupta, 2003; Orhan et al, 2005; Watanabe et al, 2005), laparoscopic varicocelectomy with 5 studies (Mehan et al, 1992; Jarow et al, 1993; Enquist et al, 1994; Milad et al, 1996; Watanabe et al, 2005), radiologic embolization with 6 studies (Vermeulen et al, 1986; Yavetz et al, 1992; Nieschlag et al, 1993; Ferguson et al, 1995; Shlansky‐Goldberg et al, 1997; Nabi et al, 2004), and macroscopic inguinal (Ivanissevich) with 3 studies (Newton et al, 1980; Marks et al, 1986; Yavetz et al, 1992). To compare postoperative recurrence and hydrocele formation rates among the techniques used for varicocele repair, the analysis included retroperitoneal high ligation with 4 studies (Yavetz et al, 1992; Çayan et al, 2000; Ghanem et al, 2004; Watanabe et al, 2005), microsurgical technique with 10 studies (subinguinal, 6; inguinal, 4; 1 study to compare both approaches; Goldstein et al, 1992; Ito et al, 1993; Marmar and Kim, 1994; Çayan et al, 2000; Jungwirth et al, 2001; Kamal et al, 2001; Ghanem et al, 2004; Orhan et al, 2005; Watanabe et al, 2005), laparoscopic varicocelectomy with 5 studies (Mehan et al, 1992; Jarow et al, 1993; Enquist et al, 1994; Milad et al, 1996; Watanabe et al, 2005), radiologic embolization with 3 studies (Yavetz et al, 1992…”

Section: Methodsmentioning

confidence: 99%

“…In addition, interventional failure with the radiologic approach and major complications with the laparoscopic approach were reviewed. To compare spontaneous pregnancy rates among the techniques used for varicocele repair, the approaches in this review included retroperitoneal high ligation (Palomo technique) with 10 studies (Cockett et al, 1984;Baker et al, 1985;Menchini-Fabris et al, 1985;Rageth et al, 1992;Hirokawa et al, 1993;Nieschlag et al, 1993;Madgar et al, 1995;Shlansky-Goldberg et al, 1997;Ç ayan et al, 2000;Watanabe et al, 2005), microsurgical subinguinal or inguinal technique with 12 studies (subinguinal, 7; inguinal, 5; 1 study to compare both approaches; Goldstein et al, 1992;Ito et al, 1993;Marmar and Kim, 1994;Ç ayan et al, 2000Jungwirth et al, 2001;Kamal et al, 2001;Perimenis et al, 2001;Kumar and Gupta, 2003;Orhan et al, 2005;Watanabe et al, 2005), laparoscopic varicocelectomy with 5 studies (Mehan et al, 1992;Jarow et al, 1993;Enquist et al, 1994;Milad et al, 1996;Watanabe et al, 2005), radiologic embolization with 6 studies (Vermeulen et al, 1986;Yavetz et al, 1992;Nieschlag et al, 1993;Ferguson et al, 1995;Shlansky-Goldberg et al, 1997;Nabi et al, 2004), and macroscopic inguinal (Ivanissevich) with 3 studies (Newton et al, 1980;Marks et al, 1986;Yavetz et al, 1992). To compare postoperative recurrence and hydrocele formation...…”

Section: Methodsmentioning

confidence: 99%

Treatment of Palpable Varicocele in Infertile Men: A Meta‐analysis to Define the Best Technique

Çayan

¹

,

Shavakhabov

²

,

Kadıoğlu

³

2009

Journal of Andrology

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To date, there have been no randomized, controlled, prospective clinical studies that compare various techniques to describe the best method for the treatment of varicocele in infertile men. This meta-analysis aims to address the best treatment modality for palpable varicocele in infertile men. A MEDLINE search was performed for articles published between January 1980 and April 2008, and we analyzed 36 studies reporting postoperative spontaneous pregnancy rates and/or complication rates after varicocele repair using various techniques in infertile men with palpable unilateral or bilateral varicocele. Spontaneous pregnancy rates and postoperative complications such as hydrocele formation, recurrence, or persistence were compared among the techniques. In addition, interventional failure with radiologic embolization and reported complications with the laparoscopic approach were reviewed. Overall spontaneous pregnancy rates were 37.69% in the Palomo technique series, 41.97% in the microsurgical varicocelectomy techniques, 30.07% in the laparoscopic varicocelectomy techniques, 33.2% in the radiologic embolization, and 36% in the macroscopic inguinal (Ivanissevich) varicocelectomy series, revealing significant differences among the techniques (P 5 .001). Overall recurrence rates were 14.97% in the Palomo technique series, 1.05% in the microsurgical varicocelectomy techniques, 4.3% in the laparoscopic varicocelectomy techniques, 12.7% in the radiologic embolization, and 2.63% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (P 5 .001). Overall hydrocele formation rates were 8.24% in the Palomo technique series, 0.44% in the microsurgical varicocelectomy techniques, 2.84% in the laparoscopic varicocelectomy, and 7.3% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (P 5 .001). We conclude that the microsurgical varicocelectomy technique has higher spontaneous pregnancy rates and lower postoperative recurrence and hydrocele formation than conventional varicocelectomy techniques in infertile men. However, prospective, randomized, and comparative studies with large number of patients are needed to compare the efficacy of microsurgical varicocelectomy with that of other treatment modalities in infertile men with varicocele.

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Prognosis of Subfertility in Men with Corrected or Uncorrected Varicocele

Vermeulen

¹

,

Vandeweghe

²

,

Deslypère

³

1986

Journal of Andrology

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To evaluate whether correction of varicocele improves fertility, pregnancy rates were compared in 115 varicocele patients consulting for infertility and having oligozoospermia, asthenospermia, or teratozoospermia, in any combination, and FSH levels within the normal range. Ninety of these patients had corrected, and 25 had uncorrected varicoceles, respectively. The value of clinical and seminal parameters for predicting the eventuality of pregnancy for varicocele patients was also studied. Although both groups were comparable in terms of duration of infertility, mean age, sperm density, motility or fertility index, cumulative pregnancy rates over 12 months were similar, whether or not the varicocele was corrected. The value of clinical or seminal parameters, in any combination, for the prediction of outcome for varicocele patients was poor. The prognosis was poor for men with less than 15% of spermatozoa with normal morphology, FSH levels higher than the mean + 3 SD of those values found in young fathers, and a fertility index below 3. In subjects who achieved pregnancy within one year, pretreatment sperm characteristics were similar in both the corrected and uncorrected groups. Correction of varicocele slightly improved sperm characteristics. It seems likely that in most men with subfertility and varicocele, other factors besides venous reflux are responsible for their infertility.

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Varicocele: “A Never Ending Story”

Fabris¹

1996

Vascular Andrology

0

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Varicocele and Male Subfertility: Prognostical Criteria in the Surgical Treatment

Cited by 4 publications

References 14 publications

Treatment of Palpable Varicocele in Infertile Men: A Meta‐analysis to Define the Best Technique

Treatment of Palpable Varicocele in Infertile Men: A Meta‐analysis to Define the Best Technique

Prognosis of Subfertility in Men with Corrected or Uncorrected Varicocele

Varicocele: “A Never Ending Story”

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