Téma: 

Current concepts in pathophysiology, diagnosis and treatment of varicocele

Igor Sopilko

Objective: Although varicocele is generally regarded as the most common and easily correctable cause of male factor infertility, controversy continues to surround its pathophysiology and treatment. The purpose of this review is to offer current concept of pathophysiology, evaluation and treatment of varicocele. Material and methods: Information obtained from literature was reviewed by author and current approach in management of varicocele is presented. Results: Varicocele is defined as a dilatation of the pampiniform venous plexus that surrounds the testis. Clinically, idiopathic varicoceles occur more commonly as isolated left-sided lesions and are usually asymptomatic. The preponderance of experimental data from clinical and animal models demonstrates a deleterious effect of varicoceles on spermatogenesis. Testicular temperature elevation and venous reflux appear to play an important role in varicocele-induced testicular dysfunction, although the exact patophysiology of varicocele-induced damage is not completely understood. Most likely, varicocele is the result of a multifactorial process. The best method for diagnosis remains a good clinical examination. The surgical correction of varicocele is the most commonly performed operation for the treatment of male infertility. The introduction of microsurgical repair has minimized complications. Improvements in seminal variables, testicular size and testicular histology have been observed after varicocelectomy. Conclusion: Having reviewed the published medical reports on the pathophysiology and treatment outcomes of varicocele our understanding of the mechanism by which the varicocele adversely affects spermatogenesis is still very limited. Unless the pathophysiology of varicocele is better understood our ability to assess the impact of patient’s varicocele on his semen analysis and our ability to predict the response to varicocele treatment will remain limited. Continuing research into the exact pathophysiology of varicocele and their associated causes of poor semen quality will hopefully lead to better selection of patients for varicocele treatment in the future.

Ročník 2007  Témy časopisu Clinical urology 3 / 2007

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