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Aiello G, Morlacco A, Motterle G, Bianco M, Mancini M, Beltrami P, Zattoni F, Iafrate M, Dal Moro F. Efficacy and safety of antegrade sclerotherapy for varicocele in pediatric patients: A systematic review. Urologia 2024:3915603241252916. [PMID: 38767314 DOI: 10.1177/03915603241252916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Antegrade sclerotherapy (Tauber's) procedure has been extensively used for the minimally-invasive treatment of varicocele; however, the results in the pediatric population are less defined. This systematic review evaluates the efficacy and safety of antegrade sclerotherapy for varicocele in the pediatric population. EVIDENCE ACQUISITION The review was conducted following the PRISMA guidelines. Systematic research of available literature in English language from 1980 until May 2022 was conducted through EMBASE, MEDLINE, Cochrane Library, and NIH Registry of Clinical Trials. For each study, information was gathered regarding the study design, the inclusion/exclusion criteria, the indications for treatment, the success rate and the complications. When available, the details about sperm analysis were reported. EVIDENCE SYNTHESIS The 10 studies were included in the final sample (564 patients). Median age of patients ranged 13.3-15.3 years. The indications for scleroembolization varied in the different studies, while most studies included patients with clinical G2-G3 varicocele and clinical symptoms or testicular asymmetry. The treatment was successful in 88%-98% of the patients, while the complication rate was <5%. CONCLUSION Tauber's sclerotherapy is a safe and effective treatment for varicocele also in the pediatric population. Further studies with standardized inclusion criteria are needed to provide higher level of evidence and compare the outcomes of antegrade sclerotherapy with the other available techniques.
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Affiliation(s)
- Giuseppe Aiello
- UOC Urologia, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università di Padova e Azienda Ospedale Università Padova, Padova, Italy
| | - Alessandro Morlacco
- UOC Urologia, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università di Padova e Azienda Ospedale Università Padova, Padova, Italy
- UOC Urologia Pediatrica, Azienda Ospedale Università Padova, Padova, Italy
| | - Giovanni Motterle
- UOC Urologia, Ospedale di Piove di Sacco (PD), AULSS 6 Euganea, Padova, Italy
| | - Marta Bianco
- UOC Urologia Pediatrica, Azienda Ospedale Università Padova, Padova, Italy
| | - Mariangela Mancini
- UOC Urologia, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università di Padova e Azienda Ospedale Università Padova, Padova, Italy
| | - Paolo Beltrami
- UOC Urologia, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università di Padova e Azienda Ospedale Università Padova, Padova, Italy
- UOSD Endourologia, Azienda Ospedale Università Padova, Padova, Italy
| | - Fabio Zattoni
- UOC Urologia, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università di Padova e Azienda Ospedale Università Padova, Padova, Italy
| | - Massimo Iafrate
- UOC Urologia, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università di Padova e Azienda Ospedale Università Padova, Padova, Italy
| | - Fabrizio Dal Moro
- UOC Urologia, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università di Padova e Azienda Ospedale Università Padova, Padova, Italy
- UOC Urologia Pediatrica, Azienda Ospedale Università Padova, Padova, Italy
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Huyghe E, Methorst C, Faix A. [Varicocele and male infertility]. Prog Urol 2023; 33:624-635. [PMID: 38012908 DOI: 10.1016/j.purol.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d'urologie (AFU) Comité d'andrologie et de médecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional information. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances. METHODS Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023. RESULTS Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery. CONCLUSION Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.
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Affiliation(s)
- E Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR DEFE, Inserm 1203, université de Toulouse, université de Montpellier, Toulouse, France.
| | - C Methorst
- Service de médecine de la reproduction, hôpital des Quatre Villes, Saint-Cloud, France
| | - A Faix
- Clinique Saint-Roch, 560, avenue du Colonel-Pavelet-dit-Villars, 34000 Montpellier, France
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Kalantan M, Vienney N, Guillot Tantay C, Roupret M, Akakpo W. [Results of subinguinal microsurgical varicocelectomy]. Prog Urol 2023; 33:481-487. [PMID: 37537033 DOI: 10.1016/j.purol.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/09/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The subinguinal microsurgical varicocelectomy is considered as the gold standard surgical technique for the treatment of varicocele. The objective of this study is to evaluate the results of this technique on the resolution of pain and the parameters of sperm analysis. METHODS Single-center, retrospective study that includes 22 patients who have been operated over a period of six months for a clinically palpable varicocele via the microsurgical subinguinal technique. Nine patients were operated for pain and 13 patients for infertility with an abnormality of their sperm analysis. RESULTS All the patients operated for pain had a complete resolution of pain at the postoperative follow-up (3 months). Concerning the patients operated for infertility, 76.92% of the patients had a normal sperm analysis, 7.69% of the patients presented a partial improvement, and 15.39% of the patients without any improvement. Analysis of sperm's parameters at 3 months showed a significant improvement in the morphology (4.3% vs 6.69% of typical forms according to Kruger ; P<0.05) and mobility (progressive mobility 15.6% vs 23% postoperatively; P<0.01). A non-significant improvement (low sample) in the concentration was noted (21.58 million/mL preoperative vs 34.9 million/mL postoperative, P=0.08). Pregnancies are noted in 38.5% of patients. A postoperative complication was noted with surgical site infection resolved with antibiotics. CONCLUSION This single-center study confirms that the treatment of varicocele by subinguinal microsurgical route is an effective therapeutic strategy on symptomatic varicocele and in infertile men. This technique is associated with few complications. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- M Kalantan
- Service d'urologie, hôpital Robert-Debré, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France.
| | - N Vienney
- Service d'urologie, hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - M Roupret
- Service d'urologie, hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - W Akakpo
- Service de chirurgie urologique, groupe hospitalier privé Ambroise-Paré, 48, ter boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France.
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Tandon S, Bennett D, Mark Nataraja R, Pacilli M. Outcome following the surgical management of varicocele in children and adolescents: a systematic review and meta-analysis. Ther Adv Urol 2023; 15:17562872231206239. [PMID: 37868369 PMCID: PMC10590051 DOI: 10.1177/17562872231206239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background The ideal surgical approach for the management of varicocele in children and adolescents remains controversial. Several techniques are available including artery- or lymphatic-sparing with optical magnification (via open inguinal or sub-inguinal approach), laparoscopic, antegrade and retrograde embolization/sclerotherapy. Objectives We aimed to appraise the clinical outcomes of these techniques in children and adolescents. Data Sources and Methods A systematic review was conducted (1997-2023). Meta-analysis or proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random effects model was conducted. Results are expressed as overall proportion % and 95% confidence interval (CI). Results We identified 1910 studies; 632 duplicates were removed, 1278 were screened, 203 were reviewed and 56 were included, with 12 reporting on 2 different techniques (total of 68 data sets). Optical magnification via inguinal approach (498 cases): recurrence 2.5% (0.6-5.6), hydrocele 1.6% (0.47-3.4), testicular atrophy 1% (0.3-2.0), complications 1.1% (0.2-2.6); optical magnification via sub-inguinal approach (592 cases): recurrence 2.1% (0.7-4.4), hydrocele 1.26% (0.5-2.3), testicular atrophy 0.5% (0.1-1.3), complications 4% (1.0-8.8). Laparoscopic with mass-ligation/division (1943 cases): recurrence 2.9% (1.5-4.6), hydrocele 11.4% (8.3-14.9); complications 1.5% (0.6-2.9); laparoscopic with lymphatic-sparing (974 cases): recurrence 2.4% (1.5-3.5), hydrocele 1.2% (0.45-3.36), complications 1.2% (0.05-3.9); laparoscopic with artery-sparing (228 cases): recurrence 6.6% (2.3-12.9), hydrocele 6.5% (2.6-12.0). Antegrade embolization/sclerotherapy (403 cases): recurrence 7.6% (5.2-10.4), hydrocele 0.8% (0.17-1.9), technical failure 0.6% (0.1-1.6), complications 4.0% (2.3-6.1); retrograde embolization/sclerotherapy (509 cases): recurrence 6.9% (4.6-9.5), hydrocele 0.8% (0.05-2.5), technical failure 10.2% (4.6-17.6), and complications 4.8% (1.0-11.2). Conclusion The recurrence rate varies between 2.1% and 7.6% and is higher with the embolization/sclerotherapy techniques. Post-operative hydrocele rate varies between 0.8% and 11.4% and is higher with the laparoscopic mass-ligation/division technique. Testicular atrophy has not been reported with the laparoscopic and embolization/sclerotherapy techniques. The retrograde embolization technique is associated with 10% technical failure (inability to complete the procedure). The laparoscopic lymphatic-sparing technique is characterized by the lowest recurrence rate, incidence of hydrocele and other complications, and no reports of testicular atrophy.
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Affiliation(s)
- Sarthak Tandon
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
| | - Daniel Bennett
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
| | - Ramesh Mark Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Level 5, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Torkian P, Rosenberg M, Talaie R, Golzarian J. Varicocele Embolization: Interventional Radiologist's Perspective. Semin Intervent Radiol 2022; 39:581-586. [PMID: 36561796 PMCID: PMC9767774 DOI: 10.1055/s-0042-1759734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The goal of this article is to review the patient selection criteria, technical pearls, and outcomes of percutaneous varicocele embolization. This article will provide a brief overview of the history of the procedure, angiographic approach, and materials used in contemporary embolization. The success rates and complications of the varicocele embolization will also be discussed.
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Affiliation(s)
- Pooya Torkian
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Michael Rosenberg
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Reza Talaie
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Jafar Golzarian
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
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Hung JWS, Chung KLY, Yam FSD, Lai NTY, Suen MMY, Chin VHY, Leung MWY. Long lasting effect on testes following methylene blue injection in laparoscopic lymphatic sparing varicocelectomy. J Pediatr Urol 2022; 19:217.e1-217.e6. [PMID: 36464565 DOI: 10.1016/j.jpurol.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Injection of methylene blue to testis has been shown to have adverse effect in animal studies but it is still being used frequently as lymphatic mapping agent during lymphatic sparing varicocelectomy in adolescent varicoceles. We aim to report postoperative ultrasound changes after subaortic injection of methylene blue in human testes. STUDY DESIGN A retrospective observational study of consecutive patients under 18 years old undergoing laparoscopic varicocelectomy from August 2017 to August 2021 was performed. Demographics such as age, symptoms, pre-operative testicular volume was collected. Primary outcome was change on testicular ultrasound at 3, 6, 12 months after the operation. Secondary outcome was testicular volume difference between affected and unaffected testes, and growth rate of affected testis at 1 year after the operation. RESULTS Fifty-eight patients were included, with median age of 15 years old (IQR 11-18 years). Thirty-one patients had non-lymphatic sparing varicocelectomy (Group A) and 27 patients had lymphatic sparing varicocelectomy (Group B). There was no statistical difference between the mean testicular volume difference between the two groups, but hydrocele rate was significantly higher in Group A (16% vs 0%, p = 0.03). In group B, 6 patients (22.2%, p = 0.005) developed testicular change detectable by ultrasound. No statistical difference could be demonstrated for median testicular size difference (between affected and unaffected testes) at 1 year between group with and without ultrasound change (-23% vs 0%, p = 0.36). Median follow up time was 20.4 months (IQR 5-32 months). DISCUSSION Varicocele treatments improve testicular volume and increase total sperm concentration and lymphatic sparing surgery significantly decreased post-operative hydrocele rates [2]. Different agents have been used to delineate lymphatic vessels and one commonly used agent is methylene blue [10,15-16]. However it has been shown in other animal studies that intraparenchymal injection of methylene blue to rat testis result in degenerative changes [18]. Our study is the first to describe post-operative changes of human testes on imaging after lymphatic sparing varicocelectomy with subdartoic injection of methylene blue. Six patients (22.2%) demonstrated new onset testicular changes on post-operative ultrasound. Although no statistically significant testicular volume reduction was seen in the group with change on imaging, these observations may serve as a surrogate marker for testicular injury or reduced testicular function. It will be desirable for future studies if we can investigate it further with hormonal markers or semen analysis after puberty has been reached. CONCLUSION Lymphatic sparing procedure reduced post-operative hydrocele in adolescent varicocele, however long-lasting effect on testis is evident with subdartoic injection of methylene blue. This agent must be used with caution and long term follow up of these patients are needed.
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Affiliation(s)
- Judy W S Hung
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong.
| | | | - Felix S D Yam
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong
| | - Nancy T Y Lai
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong
| | | | - Vienna H Y Chin
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong
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Qiangzhao L, Xiaofeng Z, Fenghai Z, Xinsheng X, Lian shijun, Qiong L. Comparing radiological and surgical treatments for varicocele: A systematic review and meta-analysis. J Vasc Interv Radiol 2022; 33:834-840.e2. [DOI: 10.1016/j.jvir.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/12/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022] Open
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Soares-Aquino C, Vasconcelos-Castro S, Campos JM, Soares-Oliveira M. 15-Year varicocelectomy outcomes in pediatric age: Beware of genitofemoral nerve injury. J Pediatr Urol 2021; 17:537.e1-537.e5. [PMID: 34099399 DOI: 10.1016/j.jpurol.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/18/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Varicocele affects 15% of adolescents. The main postoperative complications are recurrence and hydrocele; nerve injury is rarely reported. OBJECTIVE The aims of this study are: to assess the complications after laparoscopic varicocelectomy, namely nerve injury; and to assess if nerve injury is more frequent using "hot" or "cold" ligation. STUDY DESIGN Retrospective study of varicocele cases submitted to laparoscopic correction in our department from April 2006 to March 2020. Parameters analyzed were: age, clinical findings, surgical indication, operative technique, and outcomes. Comparison was done between the "cold" versus "hot" vessel section technique. RESULTS 110 patients, with median age 14-years-old, were included. Most cases were on the left side and grade 3. Fifty patients (45%) presented complications: 21% recurrence; 18% hydrocele; and 3% genitofemoral nerve injury. Nerve injury was independent of the technique used. DISCUSSION Genitofemoral nerve injury is a complication with unknown cause and all cases are related to laparoscopic technique. It was suggested that "hot" methods of ligation of the vessels can lead to higher incidence of the lesion, but that was not corroborated in our analysis. Possible explanations for its occurrence are: a wide peritoneal window opening created with electrocautery near the internal inguinal ring; and additional dissection required to isolate the testicular veins from the artery. Prospective studies are needed to clarify the real incidence of genitofemoral nerve injury and its causes. CONCLUSIONS Laparoscopic varicocelectomy seems to be safe and effective, although complications remain frequent regardless of the technique used. Genitofemoral nerve injury is a complication rarely described that may require rehabilitation, and so awareness for this problem is of paramount importance.
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Affiliation(s)
- Carolina Soares-Aquino
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal.
| | - Sofia Vasconcelos-Castro
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal
| | - José Miguel Campos
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Miguel Soares-Oliveira
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal; Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal
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Methorst C, Akakpo W, Graziana JP, Ferretti L, Yiou R, Morel-Journel N, Terrier JE, Beley S, Carnicelli D, Hupertan V, Madec FX, Faix A, Marcelli F, Huyghe E. [Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Varicocele]. Prog Urol 2020; 31:119-130. [PMID: 33308982 DOI: 10.1016/j.purol.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022]
Abstract
The diagnosis of varicocele is clinical, carried out in supine and standing position and in Valsalva maneuver. Only clinical varicoceles have to be treated. A scrotal ultrasound with Doppler is generally performed as part of the infertile man's evaluation or in case of examination difficulties. The main indication for varicocele treatment is the adult man with clinical varicocele and abnormalities of sperm parameters, in a context of infertility of couple, with a partner having a satisfactory ovarian reserve and no cause of female infertility or a curable infertility cause. The decision to treat varicocele must therefore be taken after evaluation of the two partners of the couple. Adults with symptomatic varicocele and those with spermogram abnormalities may also be offered a cure for their varicocele even in the absence of a paternity plan, as well as adolescents with reduced testicular growth, an ipsilateral decrease testicular volume, or a size gradient between the 2 testes. The cure of varicocele can be carried out by surgery or by percutaneous embolization. Microsurgery (inguinal or subinguinal) offers lower rates of recurrence and complications than high surgical approaches (laparoscopic or not) and surgeries without magnification. It is therefore the reference surgical technique. Percutaneous retrograde embolization is a minimally invasive alternative to microsurgery offering satisfactory outcomes with rare and often benign complications. The cure for varicocele results in an improvement in sperm parameters and recent data seem to confirm that it increases the natural pregnancy rate. These results appear after a delay of 3 to 9 months (at least 1 to 2 cycles of spermatogenesis). When the sperm involvement was severe (azoospermia, severe oligospermia), the improvement of the spermogram allow (1) to avoid surgery testicular sperm extraction or (2) perform intrauterine insemination rather than ICSI.
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Affiliation(s)
- C Methorst
- Service d'urologie, CH des quatre villes, Saint-Cloud, France
| | - W Akakpo
- Service d'urologie, Hôpital universitaire de la Pitié Salpêtrière, Paris, France
| | - J P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - L Ferretti
- Service d'urologie, Hôpital d'instruction des armées Robert Picqué, Villenave-d'Ornon, France
| | - R Yiou
- Service d'urologie, CHU Henri Mondor, Créteil, France
| | | | - J E Terrier
- Hôpital privé de La Châtaignerie, Beaumont, France
| | - S Beley
- Service d'urologie, Hôpital américain, Paris, France
| | - D Carnicelli
- Service d'urologie, CHU Henri Mondor, Créteil, France
| | - V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - F X Madec
- Service d'urologie, Hôpital Foch, Suresnes, France
| | - A Faix
- 265, avenue des États du Languedoc, Montpellier
| | - F Marcelli
- Service d'urologie, CHRU de Lille, France
| | - E Huyghe
- Département d'urologie, Transplantation Rénale et Andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France.
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