title: Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study. Low‐grade left varicocele in patients over 30 years old:the effect of spermatic vein ligation on fertility Effects of varicocele on serum testosterone and changes of testosterone after varicocelectomy: a prospective controlled study. Treatment of varicocele: randomized prospective study on open surgery versus Tauber antegrade sclerotherapy. Effects of varicocele treatment in adolescents: a randomized study. Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Expression of the HSPA2 gene in ejaculated spermatozoa from adolescents with and without varicocele. Diagnosis of Pediatric Varicoceles by Physical Examination and Ultrasonography and Measurement of the Testicular Volume Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. Varicocele and adolescents: semen quality after 2 different laparoscopic procedures. Laparoscopic versus Open High Ligation of the Testicular Veins for the Treatment of Varicocele Controlled trial of high spermatic vein ligation for varicocele in infertile men. Study of the effect of varicocelectomy on sperm proteins expression in patients with varicocele and poor sperm quality by using two-dimensional gel electrophoresis Inguinal versus subinguinal varicocele vein ligation using magnifying loupe under local anesthesia: which technique is preferable in clinical practice? Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: Prospective comparison of reproductive and functional outcomes Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Effect of microsurgical subinguinal varicocele ligation to treat pain. Comparison of Inguinal Approach, Scrotal Sclerotherapy and Subinguinal Antegrade Sclerotherapy in Varicocele Treatment: A Randomized Prospective Study Update on treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital.
abstract: OBJECTIVES To compare the outcomes of the different surgical techniques used in varicocelectomy . METHODS The study included 120 patients with 147 clinical ly palpable varicoceles who underwent varicocelectomy .  The patients were r and omly allocated to one of three equal groups according to the varicocelectomy technique , which included the open inguinal approach , a laparoscopic approach , and subinguinal microscopic varicocelectomy . The assessment included operative and postoperative parameters , together with semen analysis and pregnancy rate . The mean follow-up was 18 months ( range 11 to 26 ) . RESULTS The operative time in the microscopic group was significantly longer than that for the other two groups . At follow-up , none of the patients of the microscopic group had developed postoperative hydrocele ; however , it was observed in 7 ( 13 % ) of 52 varicoceles in the open group and 10 ( 20 % ) of 50 in the laparoscopic group . This difference was statistically significant in favor of the microscopic group only . Only 1 patient in the microscopic group experienced recurrence of one varicocele compared with 7 and 9 patients in the open and laparoscopic groups , respectively . This difference was statistically significant in favor of the microscopic group only . Improvement in sperm motility and /or concentration was comparable and observed in 65 % , 67 % , and 76 % of the open , laparoscopic , and microscopic groups , respectively . Also , the pregnancy rate at 1 year was not significantly different and was 28 % , 30 % , and 40 % in three groups , respectively . CONCLUSIONS The findings of our study have demonstrated that , compared with open inguinal and laparoscopic varicocelectomy , subinguinal microsurgical varicocelectomy offers the best outcome 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 Objectives To evaluate the effect of spermatic vein ligation in patients over 30 years old and with low‐ grade left varicocele , and thus help to establish whether such patients might benefit from surgery 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 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 OBJECTIVE To study the effects of varicocele treatment on  testicular function in adolescents . DESIGN A prospect i ve controlled study in 88 r and omly selected adolescents . SETTING All participants were referred to the fertility outpatient clinic of our university hospital . PARTICIPANTS All participants with a varicocele were r and omly assigned into two groups . Group 1 ( n = 33 ) was not treated , whereas group 2 ( n = 34 ) was treated . A similar group of healthy volunteers without a varicocele served as a control group ( group 3 , n = 21 ) . INTERVENTIONS  Testes volumes were measured at intake and during follow-up using an orchiometer .  Semen analysis was performed according to st and ard procedures both at intake and after 1 year of follow-up . Serum hormone levels were determined at intake using a radioimmunoassay . Treatment was performed by means of transcatheter embolization of the left testicular vein . MAIN OUTCOME MEASURES Testes volumes and semen quality at intake and after 1 year of follow-up were compared within and between the three groups . Hormonal parameters were determined at intake only . RESULTS Before treatment , the mean left testis volume in groups 1 ( n = 26 ) and 2 ( n = 27 ) ( 20.0 mL ; 95 % confidence interval [ CI ] : 18.2 to 21.8 and 21.6 mL ; 95 % CI : 19.4 to 23.8 , respectively ) were significantly smaller than those in the control group ( n = 19 ) ( 24.5 mL ; 95 % CI : 22.7 to 26.4 ) . During follow-up , left testis volumes of the treated group were comparable with those in the control group ( 24.2 mL ; 95 % CI : 22.2 to 26.1 and 24.8 mL ; 95 % CI : 23.0 to 26.7 respectively ) and significantly ( P < 0.001 ) different from the untreated group ( 20.3 mL ; 95 % CI : 18.8 to 21.8 ) . A significant increase in left ( P < 0.01 ) as well as right ( P < 0.05 ) testis volume was observed after treatment . Semen parameters before treatment were not significantly different between the three groups . Sperm concentration increased significantly ( P < 0.01 ) from 47.4 x 10(6)/mL ( 95 % CI : 42.5 to 53.3 ) to 68.9 x 10(6)/mL ( 95 % CI : 50.6 to 87.2 ) in the treated group , whereas semen quality in the untreated and control groups did not change . Although both testes volumes and sperm concentration improved in the treated group , these phenomena were not consistently correlated to each other . CONCLUSIONS Although not apparent in all adolescents , varicocele correction result ed in an increase in left testis volume and sperm concentration . At this moment , it is not clear if early preventive treatment of varicocele in adolescents , in time , will have a positive effect on testicular function OBJECTIVES Color Doppler ultrasound ( CDU ) diagnostic criteria for varicoceles are poorly defined , and the role of CDU in diagnosing varicoceles is controversial . The purpose of this study is to assess the diagnostic accuracy of CDU for varicoceles compared to physical examination . METHODS We prospect ively studied 64 patients with CDU and collected the following data :  maximum diameter of scrotal veins , the presence of a venous plexus , sum of the diameter of up to six veins of the plexus , and the duration and amplitude of flow change on Valsalva maneuver . To avoid interphysician variation , all patients were examined by one design ated senior urologist with the sonographer remaining unaware of the findings . RESULTS  CDU parameters of 127 testis units in 64 patients were analyzed and compared to the physical findings . Fifty-nine testis units were positive and 57 units were negative for varicocele on physical examination . In 11 testis units , results of physical examination were inconclusive regarding the presence of varicocele . The commonly accepted CDU criterion for varicocele ( maximal vein diameter of 3 mm or greater ) had a sensitivity of 53 % and specificity of 91 % compared to physical examination . We developed a new scoring system incorporating the maximal venous diameter ( score 0 to 3 ) , the presence of a venous plexus and the sum of the diameters of veins in the plexus ( score 0 to 3 ) , and the change of flow on Valsalva maneuver ( score 0 to 3 ) . Using a total score of 4 or more to define the presence of  CDU-positive varicocele , we observed a sensitivity of 93 % and a specificity of 85 % when compared to physical examination . All moderate to large varicoceles found on physical examination were positive by CDU diagnosis using the scoring system , but the same group had only a 68 % positive rate by traditional CDU diagnostic criteria . CONCLUSIONS Using the proposed new scoring system , CDU has been shown to be a reliable and accurate method of diagnosis for varicoceles compared to the current reference st and ard physical examination . CDU has the advantages of being able to objective ly examine venous plexus and measure blood flow parameters and to be less observer-dependent than physical examination OBJECTIVE To evaluate mRNA expression of the HSPA2 gene in ejaculated spermatozoa in adolescents with and without varicocele . DESIGN Controlled prospect i ve study . SETTING Patients in an academic research environment . PATIENTS Adolescent patients with clinical diagnosed bilateral varicocele grade s II and III , and adolescent patients without varicocele . INTERVENTION Reverse-transcription-polymerase chain reaction ( RT-PCR ) analysis of HSPA2 gene expression in adolescents with and without varicocele . MAIN OUTCOME MEASURE Comparative RT-PCR expression analysis of HSPA2 gene mRNA , compared to the housekeeping beta-actin gene . RESULTS Sperm from adolescents with varicocele and oligozoospermia had significantly lower levels of HSPA2 gene expression than both adolescents without varicocele ( controls ) and adolescents with varicocele and normal sperm concentration ( P<.05 ) . The latter group had a nonsignificant increase in gene expression compared to the control group . CONCLUSIONS This is the first report on HSPA2 gene expression in ejaculated spermatozoa from adolescents and its relationship with varicocele pathology . Results demonstrated that HSPA2 expression was down-regulated in adolescents with varicocele and oligozoospermia compared to controls . There was a higher , albeit nonsignificant , gene expression in adolescents with varicocele and normal sperm concentration than in controls . We speculate that expression levels of this gene might be used as a molecular marker for the acquisition of thermal tolerance in ejaculated spermatozoa Introduction : The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy . The aim of this study was to prospect ively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes . Patients and Methods : This study included 68 boys with varicoceles , ranging in age from 8 to 19 years . Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography . The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography . A difference of more than 10 % or 2 ml in each testicular volume was considered significant . Results : The mean age of the boys was 13.5 ± 2.3 years . On physical examination , a left unilateral varicocele was diagnosed in 46 boys ( 67.6 % ) . The other 22 boys ( 32.4 % ) had bilateral varicoceles . Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys ( 8.7 % ) who were diagnosed by physical examination as having only left unilateral varicoceles ( grade 3 in 3 patients and grade 2 in 1 patient ) . A different of more than 10 % or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles ( 2.2 % ) . The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test ( r = 0.997 and p < 0.001 for the left testis ; r = 0.998 and p < 0.001 for the right testis ) . Conclusions : Although the management of sub clinical varicoceles remains controversial , these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles , especially in boys with high- grade left varicoceles . In contrast , scrotal ultrasonography , if considered the gold st and ard , did not show superiority over the Prader orchidometer in measuring testicular volumes 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 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 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 The purpose of this study is to determine the relative advantages of laparoscopic varicocelectomy compared to the conventional open high ligation of Palomo . We studied 193 patients who presented with varicocele . While 65 patients were treated by open high ligation of the testicular veins  , 128 patients had laparoscopic varicocelectomy .  In addition to varicocele ligation , 14 patients ( 11 % ) had laparoscopy-assisted right orchidopexy , and 5 patients ( 4 % ) had laparoscopic repair of concomitant right inguinal hernia . The mean hospital stay was 3.5 days and 1.3 days , respectively , and the recurrence rates were 10.8 % and 3.9 % , respectively . Return to normal activity was significantly earlier in Group II ( mean 4.5 days ) compared to Group I ( mean 8.9 days ) . There was no incidence of testicular atrophy in any case in the study , regardless of whether the testicular artery was ligated or preserved during surgery . We conclude that laparoscopic varicocelectomy is safe , effective and minimally invasive . In addition to its better cosmetic results and advantage in case of bilateral disease , it allows excellent exposure and control of the affected vessels . Furthermore , the shorter hospital stay and the earlier return to normal activities are very important advantages in recommending this technique as an efficient alternative to the open surgical method 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 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 OBJECTIVES To compare the intraoperative results of inguinal versus subinguinal varicocelectomy using magnifying loupe , in terms of vein ligation and arterial preservation , recurrence rate , and patient tolerability . METHODS Ninety-nine patients were r and omized to undergo a varicocele repair with an inguinal or a subinguinal approach under local anesthesia .  Data concerning the number of veins ligated and arterial preservation were recorded during each procedure . The amount of intraoperative and postoperative pain was assessed by means of visual analogue scale ( VAS ) scores . The recurrence rate was documented by color Doppler ultrasound examination . RESULTS The average number of ligated veins was 5.6 with a subinguinal dissection and 4.4 with the inguinal approach .  Inadvertent injury of the spermatic artery occurred in 6 of 47 subinguinal and 3 of 50 inguinal dissections ; the artery could not be identified during 2 subinguinal and 1 inguinal dissection . Recurrent varicocele was detected in 8 % and 14.9 % of patients after an inguinal and a subinguinal approach , respectively . The intraoperative VAS score was significantly higher in the inguinal than in the subinguinal patients ( P = 0.008 ) . CONCLUSIONS In our h and s , the inguinal approach to the spermatic cord showed a trend toward an easier preservation of the artery and a reduced incidence of persistent pathologic vein reflux . The subinguinal approach had a lower degree of intraoperative pain . On the whole , an inguinal repair might be preferable when magnifying loupe are used for varicocelectomy 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 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 OBJECTIVES To prospect ively compare sperm parameters , pregnancy and recurrence rates , and complications after  r and omized high ligation surgery versus microsurgical high inguinal varicocelectomy ( MHIV ) .  METHODS Varicocele was diagnosed by physical examination and color Doppler ultrasound in 468 patients who underwent one of two procedures : high ligation surgery ( n = 232 ) or MHIV ( n = 236 ) . The high ligation surgery was left unilateral in 142 and bilateral in 90 . The MHIV was left unilateral in 128 and bilateral in 108 . The patients were postoperatively evaluated by spermiograms and physical examination . The pregnancy rate was monitored for 2 years . RESULTS One year after surgery , 34.05 % in the high ligation group and 46.61 % in the MHIV group had a more than 50 % increase in their total motile sperm count ( P = 0.000 ) . The increase in sperm count was not statistically different between the two groups ( P = 0.1 ) , but the difference in the increase in sperm motility in the MHIV group was statistically significant ( P = 0.000 ) . Pregnancy rates at the end of 2 years reached 33.57 % in the high ligation group and 42.85 % in the MHIV group , not a statistically significant difference ( P = 0.0571 ) . The postoperative recurrence as detected by physical examination was markedly different between the two techniques . The recurrence rate was 15.51 % in the high ligation group and 2.11 % in the MHIV group ( P = 0.000 ) . Also , the incidence of postoperative hydrocele was significantly different between the two groups ( 9.09 % in the high ligation group and 0.69 % in the MHIV group ; P = 0.000 ) . CONCLUSIONS MHIV has lower recurrence and hydrocele rates , a higher increase in sperm motility , and results in higher pregnancy rates . Therefore , it should be the preferred technique for varicocelectomy OBJECTIVES The traditional treatment for a painful varicocele consists of conservative measures followed by varicocelectomy . We report our results with microsurgical subinguinal varicocele ligation to treat pain . METHODS From 1996 to 1999 , a total of 119 men underwent subinguinal microsurgical varicocele ligation for painful varicocele . The diagnosis of varicocele was based on the findings of both physical examination and color Doppler ultrasound . Patients described pain with testicular discomfort as scrotal heaviness or a dull ache . While waiting for the operation ( range 3 to 5 weeks ) , all the patients underwent a preoperative trial of conservative management for pain . RESULTS Of 119 men , 82 ( 69 % ) were available for follow-up 3 months postoperatively . Of those 82 patients , 72 ( 88 % ) reported complete resolution of pain , 4 patients ( 5 % ) partial resolution , 5 patients ( 6 % ) no change , and 1 patient ( 1 % ) epididymal discomfort that resolved with conservative measures . Of the 9 patients with partial or no change , 2 patients had reflux recurrence as seen on color Doppler ultrasound . CONCLUSIONS Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicocele when performed in selected patients 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 This prospect i ve r and omized study was performed in order to investigate the effects of interventive treatment or counselling on pregnancy rates in infertile couples in whose male partners a varicocele was diagnosed . The present report extends a previous study using the same design . A total of 125 couples were included in the current study while the previous report comprised 95 couples . Couples fulfilling the inclusion criteria were allocated r and omly either to interventive treatment ( surgical ligation or angiographic embolization of the spermatic vein ) ( n = 62 ) or to counselling as the sole treatment ( n = 63 ) . Couples were followed over the subsequent 12 months and seen at 3-monthly intervals . At the end of the 12 month period pregnancy rates , as the main outcome measure , were 29 % in the group given interventive treatment and 25.4 % in the counselled group and were not significantly different . The only significant difference found , regardless of treatment modality , was the wives ' age at admittance  :  the 34 wives achieving a pregnancy were 28.8 + /- 0.6 years ( mean + /- SE ) old while the 91 non-pregnant wives were 31.2 + /- 0.3 years old ( P < 0.05 ) . The study suggests that regular counselling of the infertile couples is as effective as interventive treatment of varicoceles in achieving pregnancies PURPOSE We review the long-term results of varicocele repair , and compare the complication rates of varicocelectomy techniques according to optical magnification use in adolescents with varicocele at a single university hospital . MATERIAL S AND METHODS We prospect ively studied 100 males 7 to 19 years old with clinical palpable varicocele . Of the patients 52 ( 52 % ) underwent left unilateral varicocelectomy  and 48 ( 48 % ) underwent bilateral varicocelectomy . Varicocelectomy was performed using a microscope in 49 patients ( 79 sites ) , loupe magnification in 25 ( 35 sites ) and no magnification in 26 ( 34 sites ) using either a subinguinal or inguinal approach . Postoperative complications were compared in all patients based on technique . Preoperative and postoperative serum hormone values and semen parameters were compared in 33 patients . RESULTS Mean postoperative followup was 30.4 + /- 13.06 months ( 12 to 65 ) . Total motile sperm count increased from 22.6 million + /- 5.16 million to 64.53 million + /- 12.3 million postoperatively , which was statistically significant ( p = 0.002 ) . Postoperative recurrence rates were 0 % in cases managed by microsurgical varicocelectomy , 2.9 % in those where loupe magnification was used and 8.8 % in those where no magnification was used . Postoperative hydrocele rates in these cases were 0 % , 2.9 % and 5.9 % , respectively . The highest rates of recurrence and hydrocele were observed in cases where no magnification was used , compared to those managed by microsurgery ( p = 0.03 and p = 0.116 , respectively ) . CONCLUSIONS Adolescent varicocele repair improves semen parameters and is a safe method with low recurrence and low complication rates . Our study suggests that the postoperative complication rate significantly decreases with use of higher magnification , such as microscopy . Microsurgical varicocele repair is the best technique with the lowest postoperative rates of recurrence and hydrocele in the treatment of adolescent varicoceles
target: 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 .
background: 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 .