Varicocele: Difference between revisions
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*** Microsurgical varicocelectomy results in return of sperm to the ejaculate in up to 50% of azoospermic men with palpable varicoceles | *** Microsurgical varicocelectomy results in return of sperm to the ejaculate in up to 50% of azoospermic men with palpable varicoceles | ||
** A randomized controlled trial of surgery versus no surgery in infertile men with varicoceles revealed a pregnancy rate of 44% at 1 year in the surgery group versus 10% in the control group. | ** A randomized controlled trial of surgery versus no surgery in infertile men with varicoceles revealed a pregnancy rate of 44% at 1 year in the surgery group versus 10% in the control group. | ||
** See Risk | ** See Risk Calculator for Predicting Changes in Semen Parameters in Infertile Men After Varicocele Repair | ||
* '''Improve Leydig cell function, resulting in increased testosterone levels''' | * '''Improve Leydig cell function, resulting in increased testosterone levels''' | ||
** In infertile men with low serum testosterone levels, microsurgical varicocelectomy alone results in substantial improvement in serum testosterone levels | ** In infertile men with low serum testosterone levels, microsurgical varicocelectomy alone results in substantial improvement in serum testosterone levels | ||
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** '''Involves ligation of the fewest number of veins''' | ** '''Involves ligation of the fewest number of veins''' | ||
*** This approach isolates the gonadal/internal spermatic veins proximally, near the point of drainage into the left renal vein. At this level, only 1-2 large veins are present, and in addition the testicular artery has not yet branched and is often distinctly separate from the internal spermatic veins. | *** This approach isolates the gonadal/internal spermatic veins proximally, near the point of drainage into the left renal vein. At this level, only 1-2 large veins are present, and in addition the testicular artery has not yet branched and is often distinctly separate from the internal spermatic veins. | ||
**** Despite the above | **** Despite the above statement, CW11 Table 25-5 suggests that the artery is not preserved with retroperitoneal approach | ||
* '''Disadvantages:''' | * '''Disadvantages:''' | ||
** '''High incidence of varicocele recurrence and hydrocele formation''' | ** '''High incidence of varicocele recurrence and hydrocele formation''' | ||