Treatment of varicocele: a comparative study of conventional open surgery, percutaneous retrograde sclerotherapy, and laparoscopy

doi:10.1016/S0090-4295(98)00178-2

Urology

Volume 52, Issue 2, August 1998, Pages 294-300

https://doi.org/10.1016/S0090-4295(98)00178-2 Get rights and content

Abstract

Objectives. To present our experience with the results of three different methods of treatment of idiopathic varicoceles.

Methods. A total of 301 patients with 417 varicoceles were retrospectively assigned into three groups according to the method of treatment. Group 1 included 94 patients with 131 varicoceles treated by open surgery. Group 2 consisted of 120 patients with 163 varicoceles treated by percutaneous retrograde sclerotherapy, and in group 3, 87 patients with 123 varicoceles were treated by laparoscopic varicocelectomy. Of all patients, 222 (73.8%) were closely followed up with clinical and Doppler ultrasound examinations 6 and 12 months after the treatment. Seminal analysis was carried out before treatment and repeated in 172 patients with subfertility or infertility 4 to 6 months after treatment.

Results. Patients in the three treatment groups were balanced regarding the different variables. The mean operative time was significantly shorter among patients with open surgery. The cost of sclerotherapy is one fourth to one fifth that of surgery and the cost of laparoscopy is double. Sclerotherapy was successful in 96 (82.8%) of 116 left varicoceles and in only 24 (51%) of 47 right varicoceles. The recurrence rate at follow-up was not significantly different among the three groups. The recurrence rate increased progressively with the increase of varicocele size from grade I to grade III in all groups. The overall incidence of postoperative complications was significantly higher among patients with open surgery. Postoperative spermiogram showed a significant increase in the density and motility and a significant reduction in the percentage of abnormal forms in all groups. The pregnancy rate was approximately similar in all groups.

Conclusions. First, sclerotherapy is best used for isolated left-sided varicoceles. Second, laparoscopy is the treatment of choice for bilateral varicoceles. Finally, open surgery still has a role in isolated right-sided varicoceles and in left-sided cases with failed sclerotherapy.

Section snippets

Material and methods

During a 3-year period, 301 patients with 417 varicoceles were treated in two centers. The diagnosis of varicocele was based on physical examination and Doppler ultrasound. The varicoceles were assigned to one of three grades on the basis of the criteria reported by Lyon et al.,11 when examining the patient in a standing position, and by Hirsh et al.,12 when using Doppler ultrasound to assess spontaneous venous activity during quiet respiration. Grade I is defined as a just palpable varicocele

Results

Of all 301 patients, varicoceles were left-sided in 175 (58.2%), right-sided in 10 (3.3%), and bilateral in 116 (38.5%). Of all 417 varicoceles, 138 (33.1%) were grade III, 187 (44.8%) were grade II, and 92 (22.1%) were grade I. The indications for varicocelectomy were testicular pain attributable to the varicocele and/or subfertility where preoperative seminal analysis showed oligoasthenoteratospermia (sperm concentration less than 20 million/mL, sperm motility less than 40%, and presence of

Comment

The frequency of bilateral or right-sided varicocele has been quoted in published reports as 10% to 15%. Recently, several authors15, 16, 17 reported a high incidence (more than 50%) of phlebographically verified right-sided venous incompetence in patients with left-sided palpable varicoceles. Ultrasound studies by McClure and Hricak18 demonstrated bilateral varicoceles in 70% of their patients. In the present study, the 42% incidence of bilateral and right varicoceles supports this high

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Cited by (90)

Comparing Endovascular and Surgical Treatments for Varicocele: A Systematic Review and Meta-Analysis
2022, Journal of Vascular and Interventional Radiology
Citation Excerpt :
The literature retrieval and screening process for the meta-analysis is illustrated in Figure 1. Following an initial literature search, 16 relevant articles (16–31) reporting on 2,138 patients were included (Table). Of these, 4 were randomized controlled trials and 12 were retrospective studies.
To conduct a systematic review and meta-analysis to assess the relative efficacy of endovascular and surgical treatments for varicocele.
PubMed and Embase databases were systematically searched to identify studies reporting on the outcomes associated with surgical or endovascular treatments of varicoceles. The studies that assessed the relative efficacy of surgical and endovascular treatments for patients with clinical varicocele were eligible for inclusion. Pooled data analyses were performed.
A total of 16 studies incorporating 2,138 patients were included in the present meta-analysis. The pooled risk ratio (RR) values suggested that rates of adverse events were lower among patients who underwent endovascular treatment than those who underwent surgical treatment (RR, 0.63; 95% confidence interval (CI), 0.42–0.93; P = .02). Both treatments were associated with similar rates of recurrence (RR, 1.03; 95% CI, 0.78–1.36; P = .82) and pregnancy (RR, 1.03; 95% CI, 0.85–1.25; P = .82).
These data demonstrate that endovascular treatment for varicocele is associated with similar rates of recurrence and subsequent pregnancy outcomes compared with surgical treatment but with lower rates of adverse events.
Molecular characteristics of varicocele: integration of whole-exome and transcriptome sequencing
2021, Fertility and Sterility
To explore the exome and transcriptome characteristics potentially underlying the pathogenesis of varicocele (VE).
Experimental study and cohort study.
Academic research laboratory and university-affiliated hospital.
Eleven VE patients whose fathers also had VE, plus 151 additional patients and 324 healthy men for variants genotyping; for the rat model, eight Sprague–Dawley male rats.
Partial ligation of renal vein was conducted to establish VE rat models for whole-transcriptome RNA sequencing (RNA-seq).
Genes with differential expression and/or harboring potential pathogenic variants detected via RNA-seq and whole-exome sequencing (WES) then subjected to population-based survey to define candidate genes of VE and analyzed via Gene Ontology and Kyoto Encyclopedia of Genes and Genomes to identify VE-involved pathways.
Whole-transcriptome RNA sequencing (RNA-seq) was performed using left spermatic veins of five rat VE models and three controls. We identified 9,688 genes and 18 pathways via RNA-seq, and via WES 160 genes harboring 279 potential deleterious variants and 16 pathways. Nine genes (AAMP, KMT2D, IRS2, SPINT1, IFT122, MKI67, DCHS1, LAMA2, and CBL) had variants in more than one patient who underwent WES, and six of these genes (AAMP, SPINT1, MKI67, IFT122, LAMA2, and DCHS1) showed differential expression. The population-based survey showed that AAMP, SPINT1, and MKI67 were strongly associated with VE risk. Together, two omic 67 data sets revealed four pathways potentially related to VE.
For the first time, we have described the exome and transcriptome characteristics of VE. The bi-omics identified novel candidate genes and pathways involving the occurrence and development of VE.
Caracteres moleculares del varicocele: integración del genoma completo y de la secuenciación del transcriptoma.
Investigar las caracteristicas del exoma y transcriptoma potencialmente subyacentes a la patogenia del varicocele (VE).
Estudio experimental y de cohortes.
Laboratorio de investigación académica y hospital afiliado a la universidad.
Once pacientes con VE cuyos padres también tenían VE, más 151 pacientes adicionales y 324 hombres sanos para las variantes genotípicas, para el modelo de ratón, ocho ratones macho Sprague-Dawley.
Se llevó a cargo la ligadura parcial de la vena renal para establecer modelos de ratón con los que realizar la secuenciación del RNA (RNA-seq) del transcriptoma completo.
Genes con expresión diferencial y/o refugio de distintas variantes patogénicas detectadas mediante RNA-seq y secuenciación del genoma complete (WES) se sometieron a un sondeo basado en la población para definir los genes candidatos a VE y fueron analizados mediante el ¨Gen ontology¨ y Kyoto Encyclopedia of Genes and Genomes¨ para identificar las vías involucradas en el VE.
La secuenciación de todo el RNA transcriptómico (RNA seq) se hizo utilizando cinco venas espermáticas izquierdas en modelos de ratón VE y en tres controles. Identificamos 9,688 genes y 18 vías mediante RNA-seq. y 160 genes albergando 270 variantes deletéreas y 16 vías mediante WES. Nueve genes (AAMP, KMT2D, IRS2, SPINT1, IFT122, MKI67, DCHS1, LAMA2 y CBL) tenían variantes en más de un paciente que se sometió a WES, y seis de esos genes (AAMP, SPINT1, MKI67, IFT122, LAMA2 y DCHS1) mostraban expresión diferencial. El sondeo basado en la población mostro que AAMP, SPINT1 y MKI67 estaban fuertemente relacionados con riesgo a sufrir VE. En total, dos conjuntos de datos omic 67 revelaron cuatro vías potencialmente relacionadas con VE.
Por primera vez, hemos descrito las características del exoma y transcriptoma del VE. La bi-ómica identificó nuevos genes candidatos y nuevas vías responsables de la incidencia y desarrollo del VE.
Surgical treatment for male infertility
2020, Actas Urologicas Espanolas
Dada la naturaleza de las múltiples causas de infertilidad masculina, algunas de ellas son «reversibles» y pueden manejarse con un procedimiento en cirugía para recuperar, en algunos casos, la capacidad fertilizante del tracto reproductivo masculino. Con la adecuada utilización de herramientas diagnósticas y del juicio clínico, el médico puede identificar candidatos ideales para estos procedimientos, y sumado a la pericia y experiencia del cirujano, conseguir resolver la barrera para retornar la posibilidad al varón para fecundar a su pareja. En este capítulo revisaremos algunos de los procedimientos quirúrgicos más utilizados en infertilidad masculina y realizaremos una breve descripción de sus detalles técnicos.
Given the nature of the multiple causes of male infertility, some of them are «reversible» and can be managed with a surgical procedure to recover, in some cases, the fertilizing capacity of the male reproductive tract. With appropriate use of diagnostic tools and clinical judgement, the physician can identify the ideal candidates for these procedures. Together with the expertise and experience of the surgeon, these treatments can manage to resolve the barrier, and men may become fertile again. In this chapter, we will review some of the most commonly used surgical procedures for the treatment of male infertility and make a brief description of their technical details.
Varicocele
2018, Oxidants, Antioxidants, and Impact of the Oxidative Status in Male Reproduction
Varicoceles are thought to be the most common attributable cause of male infertility, especially secondary infertility. While the pathophysiology of how a varicocele affects fertility is complex and multifactorial, the common end pathway is likely via the creation of reactive oxygen species (ROS) and resultant oxidative stress.
An extensive literature search ending May 2017 examining the relationship between varicocele and oxidative stress was performed using Google Scholar, PubMed, and MEDLINE. Hundreds of studies have evaluated the mechanisms of varicocele-induced oxidative stress. Many of these studies have used rat or other animal models to test their hypotheses. Fewer human studies have assessed the effects of varicocelectomy on restoring the natural balance of oxidants and antioxidants.
Varicocele-induced oxidative stress is a complex process involving multiple physiologic and cellular mechanisms likely resulting in testicular hypoxia and ischemia, which in turn create ROS and downregulate antioxidant defense mechanisms. Varicocelectomy has been shown to decrease oxidative stress and increase antioxidant concentrations. This is likely one of the main factors in improved semen parameters and pregnancy rates seen in men after varicocele repair.
Varicocele: Evaluation and pathophysiology
2018, Encyclopedia of Reproduction
Varicocele is an abnormal dilation of the pampiniform venous plexus in the spermatic cord, occurring in 15% of men. Varicocele has a higher prevalence in men with primary and secondary infertility, ∼ 35% and 75% respectively. Evaluation of a suspected varicocele includes history, physical examination and lab testing. Suggested causes of varicocele include valve incompetence, angle of insertion of the left gonadal vein into the renal vein or external compression of the gonadal vein. Varicocele can be associated with abnormal semen parameters and scrotal pain. These effects are thought to be due to increased temperature, venous pooling, accumulation of oxidative species and altered cell function.
Treatment of varicoceles: techniques and outcomes
2017, Fertility and Sterility
Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. This paper reviews the indications for treatment of varicoceles, post-intervention outcomes following treatment, and the various techniques for treatment of varicoceles. The aim of this review is to describe and compare complications associated with each approach to varicocele treatment.

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Adult UrologyTreatment of varicocele: a comparative study of conventional open surgery, percutaneous retrograde sclerotherapy, and laparoscopy

Abstract

Section snippets

Material and methods

Results

Comment

J Urol

J Urol

Urology

J Urol

Fertil Steril

J Urol

J Urol

J Urol

Zur phlebographie der vena testicularis bei varikozelenpersistenz bzw-rezidiv

Fortschr Rontgenstr

Anatomic variants of the spermatic veinimportance for percutaneous sclerotherapy of idiopathic varicocele

Radiology

Selective retrograde venography of the internal spermatic veina conclusive approach to the diagnosis of varicocele

Andrologia

Percutaneous sclerotherapy of varicoceles—an alternative to conventional surgical methods

Br J Urol

Laparoscopic varix ligation

Laparoscopic varicocelectomytechnique and results

Br J Urol

Adult Urology
Treatment of varicocele: a comparative study of conventional open surgery, percutaneous retrograde sclerotherapy, and laparoscopy