Effects of varicocele on serum testosterone and changes of testosterone after varicocelectomy: a prospective controlled study. Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns. Diagnostic accuracy of sperm DNA degradation index (DDSi) as a potential noninvasive biomarker to identify men with varicocele-associated infertility Physical activity as a possible aggravating factor for athletes with varicocele: impact on the semen profile. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: Prospective comparison of reproductive and functional outcomes Sperm chromatin condensation in infertile men with varicocele before and after surgical repair. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles. Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study. Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate. Study of the effect of varicocelectomy on sperm proteins expression in patients with varicocele and poor sperm quality by using two-dimensional gel electrophoresis Treatment of varicocele: randomized prospective study on open surgery versus Tauber antegrade sclerotherapy. Varicocele and adolescents: semen quality after 2 different laparoscopic procedures. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Male infertility after endoscopic Totally Extraperitoneal (Tep) hernia repair (Main): rationale and design of a prospective observational cohort study Comparison of Inguinal Approach, Scrotal Sclerotherapy and Subinguinal Antegrade Sclerotherapy in Varicocele Treatment: A Randomized Prospective Study
OBJECTIVE To examine the hypotheses that clinical varicoceles affect baseline serum total testosterone levels ( T ) and varicocelectomy improves T. MATERIAL S AND METHODS This prospect i ve , nonr and omized , controlled study involved 4 groups of adult men . Varicocele-infertile treatment group ( VIT ) included 66 men who underwent varicocelectomy . Thirty-three varicocele-infertile control men ( VIC ) and 33 varicocele-fertile control men ( VFC ) were only observed . Normal-control ( NC ) group included 33 fertile men without varicocele . Varicocele groups were stratified into baseline hypogonadal ( T < 300 ng/dL ) or eugonadal ( T ≥300 ng/dL ) subgroups . Main outcome measurements were between-group baseline T differences ; and within-group T changes at 6- and 12-month follow-ups of men with varicocele . P < .05 was considered significant . RESULTS Means ( st and ard deviations ) of baseline T in VIT , VIC , VFC , and NC were 347.4 ( 132.1 ) , 339.7 ( 125.8 ) , 396.6 ( 164.9 ) , and 504.8 ( 149.7 ) ng/dL , respectively . The baseline T levels of varicocele groups were comparable , whereas they were significantly low compared with NC group . At 6-month follow-up , VIT demonstrated significant T improvements ( mean change = 44.7 ng/dL ; 12.9 % ; P < .0001 ) . T changes were more remarkable among baseline hypogonadals ( mean change = 93.7 ng/dL ; 40.1 % ; P < .0001 ) compared with eugonadals ( mean change = 8.6 ng/dL ; 2.01 % ; P = .1223 ) . These improvements were persistent at 12-month follow-up . Contrariwise , VIC and VFC exhibited nonsignificant T changes . Postvaricocelectomy T changes correlated significantly and inversely with baseline T ( r = -0.689 ; P < .0001 ) . This correlation was stronger and more significant among hypogonadals ( r = -0.528 ; P = .004 ) than eugonadals ( r = -0.400 ; P = .013 ) . T improvements also exhibited significant positive correlations with preoperative and postoperative sperm concentrations . CONCLUSION Baseline T was significantly low in men with varicocele compared with normal men . Varicocelectomy yielded significant T improvements among hypogonadal men but insignificant changes in eugonadals . T changes correlated strongly and significantly with baseline T and sperm concentrations OBJECTIVE To investigate different varicocele hemodynamic patterns ( shunt type vs. stop type ) as predictors of new-onset testicular hypotrophy or recurrence after varicocelectomy . DESIGN Prospect i ve clinical study . SETTING Department of pediatric urology , children 's hospital medical center . PATIENT(S ) Seventy-four children and adolescents with varicocele . INTERVENTION(S ) Based on ultrasound findings , patients were classified into shunt-type or stop-type varicocele groups . All patients with stop-type varicocele and testicular volume discrepancy of ≥20 % underwent retroperitoneal varicocelectomy and internal spermatic vein ligation .  Patients with shunt-type varicocele and ≥20 % testicular asymmetry were r and omly divided to undergo either retroperitoneal varicocelectomy ( ligation of internal spermatic vein ) or inguinal varicocelectomy with ligation of both internal and external spermatic veins . Patients with testicular volume discrepancy of < 20 % were put on conservative management . MAIN OUTCOME MEASURE(S ) Occurrence of new-onset asymmetry among untreated patients and recurrence rate among operated patients . RESULT ( S ) Patients with shunt-type varicocele who did not undergo surgery revealed a higher risk of developing asymmetry during follow-up ( odds ratio 10.5 ) . Ligation of both internal and external spermatic veins in shunt-type patients was associated with significantly decreased rate of recurrence ( 6.3 % ) compared with retroperitoneal approach ( 30.8 % ) . CONCLUSION ( S ) Shunt-type varicocele is associated with a higher risk of testicular hypotrophy among untreated patients . In addition , recurrence rate in shunt-type patients who underwent inguinal varicocelectomy was lower compared with retroperitoneal approach Abstract Purpose Varicocele is a frequent cause of impaired testicular function that has been associated with increased levels of sperm DNA fragmentation ( SDF ) . Sperm with de grade d DNA ( DDS ) , as observed using the sperm chromatin dispersion ( SCD ) test , represent a sub population of spermatozoa with extensive DNA and nuclear protein damage . The aim of this work was to determine the usefulness of sperm DNA degradation index ( DDSi ) as a novel noninvasive biomarker to identify infertile men with varicocele . Methods A total of 593 semen sample s obtained from men attending infertility clinics were analyzed for SDF and DDS with the SCD test . These sample s were classified as : ( 1 ) fertile donors ; ( 2 ) infertile patients with least two failed assisted reproduction cycles ; ( 3 ) leukocytospermia ; ( 4 ) Chlamydia trachomatis infection ; ( 5 ) testicular cancer , and ( 6 ) infertile men with varicocele . The DDSi was obtained by determining the proportion of DDS in the whole sperm population presenting with fragmented DNA . The diagnostic accuracy of DDSi was evaluated by correlation coefficient and receiver operating characteristics analyses . Results A positive correlation ( r ≥ 0.52 ) was observed between the SDF and the frequency of de grade d sperm in all patient groups . The sperm DNA degradation index ( DDSi ) was at least twice as higher in infertile men with varicocele ( mean : 0.54 ) compared with other clinical conditions and fertile donors ( means ranging from 0.02 to 0.21 ; P < 0.0001 ) . A DDSi ≥ 0.33 identified patients with varicocele with 94 % accuracy . Conclusion Although DDS is not pathognomonic of varicocele , the DDSi is a useful noninvasive biomaker to identify infertile individuals with varicocele when examining sperm DNA damage during a routine semen analysis . This finding may alert practitioners and laboratories performing semen analysis that in the presence of an abnormal DDSi it is likely that a given patient has varicocele . It is therefore strongly recommended that such patients be referred to urologists in order to undergo a full and rological examination and be properly counseled The aim of the present study was to evaluate the influence of physical exercise on seminal parameters of male athletes with varicocele . Sixty healthy male volunteers ( athletes and non-athletes , n = 30 + 30 ) and 60 volunteers affected by varicocele ( athletes and non-athletes , n = 30 + 30 ) were r and omly selected for a clinical study . All subjects provided at least two semen sample s for routine microscopic analysis . Determinations for basal luteinizing hormone ( LH ) , follicle stimulating hormone ( FSH ) , prolactin , oestradiol , total and free testosterone under resting conditions were also performed . In both groups with varicocele the percentage of total and progressive forward sperm motility and the percentage of normal spermatozoa were significantly reduced . The percentage of both progressive forward motility and normal spermatozoa were significantly lower in athletes with varicocele compared with non-athletes with varicocele ( P < 0.05 ) . Only athletes with varicocele had mean left testis volume significantly lower than the contralateral testis ( P < 0.05 ) . No modifications of hormonal parameters at rest were observed in any groups . Physical activity might represent an aggravating factor for spermatogenesis in athletes with varicocele . In countries where sport eligibility is granted by an authoritative body , these results suggest the need to establish general medical criteria to guarantee the continuation of an athlete 's training whilst at the same time taking care of his reproductive health PURPOSE We compared the outcomes of 3 techniques of varicocelectomy in infertile patients with varicocele . MATERIAL S AND METHODS The study included 298 infertile patients ( 446 varicoceles ) who were r and omized to varicocelectomy by an open inguinal technique in 92 , laparoscopy in 94 and subinguinal microsurgery in 112 . The 3 techniques were compared regarding intraoperative , and early and late postoperative parameters , changes in semen parameters and the pregnancy rate . Patients were followed a + /- mean + /- SD of 21 + /- 9 months ( range 4 to 35 ) . RESULTS Operative time was significantly longer in the microscopic group . Early postoperative complications were comparable in the 3 groups . At followup none of the patients in the microsurgical group had hydrocele , while it was observed in 4 of 143 ( 2.8 % ) in the open group and in 8 of 148 ( 5.4 % ) in the laparoscopy group , representing a significance difference in favor of microsurgery . The incidence of recurrent varicocele was significantly lower in the microsurgical group than in the open and laparoscopy groups ( 4 of 155 patients or 2.6 % vs 16 of 143 or 11 % and 25 of 148 or 17 % , respectively ) . Compared to preoperative values in the 3 groups postoperative semen parameters showed significant improvement in sperm concentration , motility and morphology . The incidence of patients with improved sperm count and motility was significantly higher in the microsurgical group . The pregnancy rate at 1 year was not significantly different among the 3 groups . CONCLUSIONS Compared with open and laparoscopic varicocele treatment microsurgical varicocelectomy has the advantages of no hydrocele formation , a lower incidence of recurrent varicocele , and better improvement in sperm count and motility Background Varicocele is a condition characterized by dilated , tortuous veins within the pampiniform venous plexus of the scrotal sac . Presence of varicocele is associated with an increased risk of alteration of semen parameters . The objective of this study was to compare the current st and ard in varicocele treatment procedures : sub-inguinal microscopic ligation to percutaneous embolization in terms of semen parameters improvement , fertility , and morbidity at the university hospital of Toulouse ( France ) . Seventy six patients with clinical varicocele , alteration of semen parameters and infertility , underwent either procedure ( microsurgery in 49 case performed by a single surgeon and embolization in 27 cases ) and were prospect ively analyzed . Outcome measures were : semen parameters , spontaneous pregnancies , pain , side effects , recovery time and overall satisfaction . All patients were contacted in January 2015 in order to determine reproductive events . Results Preoperatively , there was no difference in clinical and biological items between the two groups . Postoperatively , on the overall population , there was a significant improvement of sperm concentration at 3 , 6 , 9 and 12 months ( p = < 0.001 , < 0.001 , 0.012 , 0.018 ) and sperm motility at 6 months ( p = 0.002 ) . The sperm concentration was higher at 6 months in the percutaneous embolization group ( 13.42 , vs. 8.1 × 106/ml ; p = 0.043 ) . With a median follow-up of 4 years , 27 pregnancies occurred ( spontaneous pregnancy rate of 35.5%).There was no significant difference between procedures on the sperm quality , pregnancy rate , and the overall satisfaction . Patients undergoing percutaneous embolization reported a faster recovery time ( p = 0.002 ) and less postoperative pain ( p = 0.007 ) . Conclusion Our study shows that percutaneous embolization seems to be an equivalent alternative to sub-inguinal microscopic ligation in term of sperm quality improvement , pregnancy rate , and overall satisfaction with a slight advantage on post-operative morbidity . Résumé Context eLa varicocèle est une affection caractérisée par une dilatation et tortuosité des veines du plexus veineux pampiniforme du sac scrotal . La présence de varicocèle est associée à un risque accru d'altération des paramètres du sperme . Cette étude vise à comparer la norme actuelle des procédures de traitement par varicocèle : la ligature microscopique sous-inguinale à l'embolisation percutanée en termes d'amélioration des paramètres spermatiques , de fertilité et de morbidité dans l'hôpital universitaire de Toulouse(France ) . Soixante-seize patients atteints de varicocèle clinique , d'altération des paramètres spermatiques et d'infertilité ont subi une intervention  ( microchirurgie dans 49 cas réalisées par un seul urologue et embolisation dans 27 cas ) et ont fait l'objet d'une analyse prospect i ve . Les données étudiées sont les suivantes : paramètres du sperme , grossesses spontanées , douleur , effets secondaires , temps de récupération et satisfaction globale . Tous les patients ont été contactés en janvier 2015 afin de déterminer les grossesses spontanées . RésultatsEn préopératoire , il n’existait aucune différence sur les items cliniques et biologiques entre les deux groupes . Sur la population globale , on observe une amélioration significative de la concentration spermatique à 3 , 6 , 9 et 12 mois ( p = < 0,001 , < 0,001 , 0,012 , 0,018 ) et de la motilité à 6 mois ( p = 0,002 ) . La concentration de spermatozoïdes était plus élevée à 6 mois dans le groupe d'embolisation percutané ( 13,42 vs 8,09 ; p = 0,043 ) . Avec un suivi médian de 4 ans , 27 grossesses sont survenues ( taux de grossesse spontanée de 35.5%).Il n'y avait pas de différence significative entre les procédures sur la qualité du sperme , le taux de grossesse et la satisfaction globale . Les patients traités par embolisation percutanée ont rapporté un temps de récupération plus rapide ( p = 0,002 ) et moins de douleur postopératoire ( p = 0,007 ) . Conclusion Notre étude montre que l'embolisation percutanée semble être une alternative équivalente à la ligature microscopique sous-inguinale en terme d'amélioration de la qualité du sperme , du taux de grossesse et de la satisfaction globale avec un léger avantage sur la morbidité post-opératoire OBJECTIVE To assess sperm chromatin integrity in infertile men with varicocele before and after surgical repair . DESIGN Prospect i ve . SETTING Academic setting . PATIENT(S ) Seventy-two infertile men with varicocele compared with 20 healthy fertile men . INTERVENTION(S ) History taking , genital examination , semen analysis , sperm chromatin condensation assessment by aniline blue stain before and 3 months after varicocelectomy . MAIN OUTCOME MEASURE(S ) Stained sperm heads ( abnormal chromatin condensation ) before and 3 months after varicocelectomy . RESULT ( S ) The mean percentage of aniline blue-stained sperm heads was significantly higher in infertile men with varicocele compared with fertile controls . The mean percentage of stained sperm heads was significantly decreased in infertile men with varicocele 3 months after surgery compared with the preoperative data . There was a significant negative correlation between percentage of stained sperm heads and normal morphology where nonsignificant correlation was elicited regarding sperm count and sperm motility . CONCLUSION ( S ) There is a significant increase of abnormal sperm chromatin condensation in infertile men with varicocele that is markedly improved after varicocelectomy OBJECTIVE To determine whether high ligation is an effective treatment for infertile men with clinical varicocele . DESIGN A r and omized , controlled trial of high spermatic vein ligation was carried out . The patients were treated and observed for 3 years . SETTING Infertility treatment clinic and and rology laboratory in a hospital . PATIENTS Infertile men with abnormal semen analysis because of varicocele only . INTERVENTION High ligation 1 year postrecruitment ( group A ) and at the beginning of the study ( group B ) . RESULTS Among the 20 couples in group A , 2 pregnancies ( 10 % ) were achieved within the 1st year of observation period . During the year after high ligation , there were 8 pregnancies ( 44.4 % ) , and during the 2nd year after high ligation , there were 4 more pregnancies ( 22.2 % ) . In group B , 15 pregnancies ( 60 % ) occurred within the 1st year after operation . Three pregnancies ( 12 % ) and 1 pregnancy ( 4 % ) occurred during the 2nd and 3rd year , respectively . After operation in all patients of both groups , there was significant improvement in semen parameters , regardless of pregnancy occurrence . The difference in pregnancy rate ( PR ) between the operated group B and nonoperated group A during the 1st year of study was found to be highly significant . CONCLUSIONS It is concluded that in a population of infertile men presenting varicocele as the only demonstrable factor of infertility , the varicocele is clearly associated with infertility and reduced testicular function , and its correction by ligation improves sperm parameters and fertility rate . Furthermore , the highest PR in both groups occurred during the 1st year postoperation PURPOSE The left varicocele is usually larger in men with bilateral varicoceles . We hypothesized that most of the benefit of varicocelectomy would derive from repair of the larger varicocele . To test this hypothesis we prospect ively compared the effect of unilateral versus bilateral microsurgical varicocelectomy in men with large ( grade III ) or moderate ( II ) left varicocele associated with small but palpable ( I ) right varicocele . MATERIAL S AND METHODS A total of 91 patients were prospect ively followed and included in the study . Of the patients 65 underwent bilateral and 26 underwent unilateral left repair . All patients underwent preoperative and postoperative semen analysis . RESULTS Motile sperm concentration increased from 12.1+/-1.7 to 23.7+/-31.8 ( 95.8 % change ) in the bilateral group compared with an increase from 19.5+/-21.4 to 27.8+/-34.8 ( 42.6 % change ) in the unilateral group ( p<0.05 ) . Similarly , sperm concentration increased from 23.8+/-29.5 to 48.6+/-61.3 ( 157.6 % change ) in the bilateral group compared with an increase from 41.1+/-40.9 to 59.5+/-66.7 ( 44.8 % change ) in the unilateral group ( p<0.05 ) . CONCLUSIONS Bilateral varicocelectomy result ed in significantly greater improvement in post-operative seminal parameters than unilateral repair in patients with grade s II to III left varicocele associated with grade I right varicocele . Even a small , unrepaired palpable right varicocele continues to have a detrimental effect on bilateral testis function . Men with bilateral palpable varicoceles require bilateral repair OBJECTIVE To compare semen parameters , pregnancy , recurrence , and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men . DESIGN Prospect i ve , r and omized study . SETTING Ghodran General Hospital , Kingdom of Saudi Arabia . PATIENT(S ) One hundred sixty-two infertile male patients with varicocele . INTERVENTION(S ) Eighty-two patients were treated by microsurgical subinguinal varicocelectomy ( MSSIV ) ( group I ) , whereas 80 patients were treated by conventional , nonmagnified subinguinal varicocelectomy ( NMSIV ) ( group II ) . MAIN OUTCOME MEASURE(S ) The patients were postoperatively evaluated by physical examination and semen analysis after 4 and 12 months . Pregnancy rate was monitored during the follow-up period . RESULT ( S ) Postoperatively , mean sperm count and motility improved significantly in both groups : 42.7 % and 67.1 % of the MSSIV group and 23.7 % and 33.8 % of the NMSIV group showed ≥50 % improvement in sperm count and motility after 1 year . Patients having bilateral varicocele showed significantly better improvement of sperm count than those with unilateral varicocele after both MSSIV and NMSIV . The pregnancy rate at the end of the follow-up period reached 37.8 % in the MSSIV group and 21.2 % in the NMSIV group . The recurrence rate was zero in the MSSIV group and 11.3 % in the NMSIV group . The rate of hydrocele formation was 1.2 % in the MSSIV group and 8.7 % in the NMSIV group . CONCLUSION ( S ) Microsurgical subinguinal varicocelectomy has a better improving effect on sperm count and motility , higher spontaneous pregnancy rates , and lower postoperative recurrence and hydrocele formation than conventional subinguinal varicocelectomy in infertile men PURPOSE We prospect ively evaluated changes in sperm chromatin structure in infertile patients before and after surgical repair of varicocele , and the impact on the pregnancy rate . MATERIAL S AND METHODS Included in the study were 49 men with at least a 1-year history of infertility , a palpable varicocele and oligospermia . World Health Organization semen analysis and sperm DNA damage expressed as the DNA fragmentation index using the sperm chromatin structure assay were assessed preoperatively and postoperatively . Pregnancy ( spontaneous and after assisted reproductive technique ) was recorded 2 years after surgery . RESULTS Mean sperm count , sperm concentration and sperm progressive motility improved significantly after varicocelectomy from 18.3 × 10(6 ) to 44.4 × 10(6 ) , 4.8 × 10(6)/ml to 14.3 × 10(6)/ml and 16.7 % to 26.6 % , respectively ( p < 0.001 ) . The DNA fragmentation index decreased significantly after surgery from 35.2 % to 30.2 % ( p = 0.019 ) . When the definition of greater than 50 % improvement in sperm concentration after varicocelectomy was applied , 31 of 49 patients ( 63 % ) responded to varicocelectomy . After varicocelectomy 37 % of the couples conceived spontaneously and 24 % achieved pregnancy with assisted reproductive technique . The mean postoperative DNA fragmentation index was significantly higher in couples who did not conceive spontaneously or with assisted reproductive technique ( p = 0.033 ) . CONCLUSIONS After varicocelectomy sperm parameters significantly improved and sperm DNA fragmentation was significantly decreased . Low DNA fragmentation index values are associated with a higher pregnancy rate ( spontaneous and with assisted reproductive technique ) . We suggest that varicocelectomy should be considered in infertile men with palpable varicocele , abnormal semen analysis and no major female factors Purpose To compare proteomic profiles of spermatozoa from patients with varicocele and poor sperm quality before and after varicocelectomy . Methods This work was design ed as a prospect i ve and observational study . The study was based on 20 men with varicocele grade 3 and poor sperm quality undergoing varicocelectomy at the Fertility Unit of Royan institute in 2009 . Two semen sample s were collected , one before varicocelectomy and the other after surgery . Protein separation was done by two-dimensional protein electrophoresis , and analyzed by gel densitometry and mass spectrometry . Differential sperm protein expression levels were measured by gel densitometry . Results Comparison of the sperm parameters showed that sperm motility and concentration were increased after varicocelectomy . At the level of protein , a total of 3 protein spots were identified whose expression was significantly lower in sperm sample s before varicocelectomy compared with after surgery including heat shock protein A5 ( HSPA5 ) , superoxide dismutase 1 ( SOD1 ) and δ-subunit of the catalytic core of mitochondrial adenosine triphosphate synthase ( ATP5D ) . Conclusions High grade varicocoele affects sperm protein expression presumably because of increasing testicular temperature . These proteins play essential roles in sperm production , DNA integrity protection , and sperm motility . This novel study demonstrates that varicocelectomy can improve both sperm quality and proteins expression The goal of this r and omized prospect i ve study in patients with varicocele was to evaluate the outcome following open surgery with inguinal approach versus ante grade sclerotherapy according to the Tauber procedure . From January 2002 to November 2003 , we recruited 64 patients with left varicocele for this study . All patients were clinical ly examined , before surgery and again 8 months postsurgery , by objective examination , scrotal color Doppler ultrasound , and semen analysis . These patients were r and omized in a balanced 4-block pattern : depending on r and omization , the patients underwent open surgery ( group A : 32 patients ) or ante grade sclerotherapy according to the Tauber procedure ( group B : 32 patients ) . At the current follow-up , it is possible to evaluate all the patients for whom we have preoperative and postoperative Doppler imaging and semen analysis . An analysis of seminal parameters shows a statistically significant improvement of the rate of fast progressive spermatozoa ( P < .05 ) and reduction in immotile spermatozoa ( P < .01 ) in those patients who underwent sclerotherapy compared to the patients who underwent open surgery . The outcomes of all other parameters ( number and morphology ) are fully comparable . Operating time is decidedly shorter for ante grade sclerotherapy ( P < .01 ) , but there are no significant differences in terms of early or late postoperative complications . It is widely known that varicocele is a condition found in 9 % to 23 % of the male population around the world ; this percentage rises to 40 % among infertile males . The treatment of this condition not only resolves clinical symptoms but also stops continuous damage to spermatogenesis , thereby potentially improving fertility . Our experience demonstrates that sclerotherapy ( Tauber procedure ) combines shorter surgical time and faster recovery of normal daily activities with significant improvement in sperm motility The aim of this prospect i ve study was to assess long-term functional results ( spermiograms ) in subjects who underwent laparoscopic varicocelectomy via either of 2 procedures ( ligation or preservation of testicular artery ) . A total of 122 patients underwent laparoscopic varicocelectomy performed via either of the 2 different procedures : complete ligation of the spermatic vessels or preservation of the spermatic artery . After surgery when patients achieved 18 years , they were asked to undergo semen analysis . Spermiogram results were divided into 2 subgroups : " normal " and " abnormal . " We analyzed volume , sperm count per mL , percentage of motile spermatozoa , percentage of normal spermatozoa , and percentage of vitality for each group . Both groups showed the same results in terms of " normal " and " abnormal " spermiograms ( World Health Organization criteria ) , but analysis showed higher sperm concentration per mL , sperm motility , volume , vitality , and rate of morphologically normal sperm for the group with arteries preserved and " normal " spermiograms ( P < .01 ) . Analysis of data from the spermiograms showed that preservation of the testicular artery was the best possible option in terms of semen quality . Therefore , we believe that surgical treatment of varicocele should be carried out using procedures involving artery preservation OBJECTIVES To compare and assess objective ly the postoperative outcome parameters of both microsurgical subinguinal artery sparing and retroperitoneal high ligation techniques for varicocele in infertile men . METHODS We performed a prospect i ve study that included 413 consecutive patients who presented with varicocele . Of the 413 patients , 304 underwent subinguinal varicocelectomy ( group 1 ) and 109 patients underwent high ligation varicocelectomy ( group 2 ) .  Subinguinal varicocelectomies were performed under local anesthesia , with intravenous propofol sedation administered as needed . The operating microscope ( x10 to x16 ) was used to spare the arteries and lymphatics . High ligation was performed through a retroperitoneal approach . RESULTS All patients went home on the evening after surgery with minimal discomfort . No intraoperative complications occurred . The internal spermatic artery was identified in all microvaricocelectomy cases . No testicular atrophy occurred in either group . Five ( 1.6 % ) and seven ( 6.4 % ) hydroceles were identified at the 3-month postoperative visit in groups 1 and 2 , respectively . CONCLUSIONS Microvaricocelectomy is safe and effective and associated with a rapid recovery and minimal morbidity . However , it requires microsurgical training Background To describe the rationale and design of an observational cohort study analyzing the effects of endoscopic Totally Extraperitoneal ( TEP ) hernia repair on male fertility ( MAIN study ) . Methods and design The MAIN study is an observational cohort study design ed to assess fertility after endoscopic TEP hernia repair . The setting is a high-volume single center hospital , specialized in TEP hernia repair . Male patients of 18 - 60 years of age , with primary , reducible , bilateral inguinal hernias and no contraindications for endoscopic TEP repair are eligible for inclusion in this study . Patients with an ASA-classification ≥ III and patients with recurrent and /or scrotal hernias and /or a medical history of pelvic surgery and /or radiotherapy , known fertility problems , diabetes and /or other diseases associated with a risk of fertility problems , will be excluded . The primary outcome is the testicular perfusion before and 6 months after TEP hernia repair ( assessed by means of a scrotal ultrasonography ) . Secondary endpoints are the testicular volume ( Ultrasound ) , semen quality and quantity and the endocrinological status , based on serum levels of the sexual hormones follicle-stimulating hormone ( FSH ) , luteinizing hormone ( LSH ) , testosterone and inhibin B before and 6 months after TEP hernia repair . Discussion The use of polypropylene mesh is associated with a strong foreign body reaction which could play a role in chronic groin pain development . Since the mesh in ( endoscopic ) inguinal hernia repair is placed in close contact to the vas deferens and spermatic vessels , the mesh-induced inflammatory reaction could lead to a dysfunction of these structures . Relevant large and prospect i ve clinical studies on the problem are limited . This study will provide a complete assessment of fertility in male patients who undergo simultaneous bilateral endoscopic TEP hernia repair  , by analyzing testicular perfusion and volume , semen quantity and quality and endocrinological status before and 6 months after TEP repair . Trial registration The MAIN study is registered in the Dutch Trial Register ( NTR2208 We compared outcome and complications of three simple  varicocelectomy techniques . Groups were divided according to whether they would receive the Ivanissevich technique ( n = 55 ) , Tauber ’s technique ( n = 51 ) or subinguinal sclerotherapy ( n = 49 ) . Selection criteria were : infertility > 1 year , subnormal semen , sonographic diameter of veins > 3 mm and time of regurge > 2 s. Patients were r and omly assigned to the groups of treatment , with follow-up every 3 months for 1 year . Improvement was only in sperm count and total motility for all groups . Pregnancy rates were 20 , 13.73 and 12.24 % , respectively , with no significant difference between groups . Hydrocele occurred only in the group which received the Ivanissevich technique ( 5.5 % ) . Tauber ’s technique is simple ; however , it has the disadvantage of multiple branching of small veins
Taken together , the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy .
Abstract Despite being first described two thous and years ago , the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility , hypogonadism , and chronic orchidalgia .
The underlying mechanisms remain poorly understood and likely include hypoxia , oxidative stress , hyperthermia , anatomical aberrations , and genetics as primary components .
Despite a high prevalence amongst asymptomatic fertile men , varicoceles paradoxically also represent the most common correctable cause for male infertility .
In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations .
We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain .