Varicocele is one cause of male infertility. Does surgical intervention benefit varicocele patients, regardless of the grade?
Patients with vague testicular pain may also have varicocele. Generally these patients are young and unmarried. Please do not operate. Testicular pain is no indication for operation. Infertility is. Though results are not predictable.
Clinically- palpable varicocele with abnormal semen quality can gain benefit from surgery. WHO & Madgascar studies proved statistically significant improvement in improvement of semen quality and paternity. other studies reported no improvement .No evidence of improvement in mild and subclinical varicocele
No absolute indication to surgery can be done. European Guides conclude: Although treatment of varicocele in adolescents may be effective, there is a significant risk of overtreatment.
The only prospective randomized study of treatment of subclinical varicocele failed to show that therapy benefited fertility.
I suggest lecture of Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet 2003;361(9372):1849-1852.
I also suggest to read the following Treatment of varicocele in subfertile men: The Cochrane Review--a contrary opinion.
Ficarra V, Cerruto MA, Liguori G, Mazzoni G, Minucci S, Tracia A, Gentile V.
Eur Urol. 2006 Feb;49(2):258-63. Epub 2006 Jan 4. Review.
I suggest to treat only infertile males with continuous reflux
No definitely not. There are lots of varicoceles that are of no clinical consequence. If they are causing reproducible pain, asymetric testicle size in an adolescent, or fertility issues, then perhaps yes. However, one should be careful repairing varicocels for diffuse, or non-specific scrotal pain.
RESOUNDING NO. Only clinically palpable varicoceles with infertility or pain or occupational purpose need surgery. . Infact there is no need of finding varicocele by sonography which is not palpable
This question is coming back and back again since the last 25 years. There is no abosulute evidence that operating varicoceles do improve the fertilising capacity of the semen. As mny suggested above it is a matter of the patients comfort.
Clinically palpable varicocele is treated most commonly for occupational purpose as in india a large number of youths are given temporary unfitness due to varicocele and we made them fit for the job and they get employment. Other indications may be infertility.
No there are no evidences about surgery and improvement in the fertility outcome. Some studies actually do not find improvement in DNA fragmentation as well after surgery. Sometimes it is suggested to do surgery if the pain is significant and there are other factors as testicular atrophy(shrinking of the testicle) in same cases surgery can improve pain and the testicle goes back to the original size.
Results from a meta analysis reported in Lancet some years back clearly shows that Varicocele repair does not seem to be an effective treatment for male or unexplained sub fertility. Moderate to severe varicocoele ligation does improve seminal parameters with statistically significantly improving the chances for fertility.
Hope this helps:
An RCT comparing different surgical treatments of varicocele showed no clear benefit in favour of any technique in relation to improving sperm parameters. Also, pregnancy
rates at 1 yr after surgery were comparable for open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy However, microscopic varicocelectomy is
associated with significantly less recurrence and potentially fewer complications such as hydrocele, but it also requires more operating time and microsurgical training.
European Association of Urology Guidelines on Male Infertility: The 2012 Update
Personally I indicate the surgery only in untreatable pain due to venous ectasia and in infertile men as last choice before PMI
I think that grade 2 to 3 which is palpated and affect fertility ,cause persistent pain is indicated for intervention.
Clinically palpable varicocele in symptomatic patient with pain and or infertility needs an operation.
For patients with pain and discomfort: there is a lot of overtreatment reflecting into a low satisfaction rate of patients. At least patients selected for treatment need to be informed on that issue. According to principal guidelines: in case of subfertility the indication remains doubtful. No data supports the evidence.
Any suggestion for 34yo caucasian gentelman (trying pregnancy for 3 years. wife 30yo) and significant as well as permanent hemospermia (since 17 yo)?
Full workup including Pelvic MRI, TRUS, etc. quite normal.
I assume he has a varicocele. In case the semen shows oligospermia an intervention can be offered. Interesting research showed a significant decrease of DNA-fragmentation-index (p 0.019) after surgery in 49 subjects. This resulted in 37% spontaneously conceived pregnancy rate of the couples. (Smit M et al J Urol 189( 1 suppl): S146-150). This is what use at consultation of the patient/couple.
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