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Management of Recurrent Varicocele

  • Giorgio Ivan Russo
  • Ege Can SerefogluEmail author
Chapter

Abstract

Varicocele is defined as the dilation of the veins of the pampiniform plexus. It has been reported that at least 15% of adolescent males and more than 30% of infertile men suffer from varicocele. Although primary surgical intervention for varicocele is feasible, varicocele recurrence is not a rare complication of this procedure. The actual rates of varicocele recurrence are not clear as the probability of recurrence varies according to the studied population, indication of the initial surgery and severity of the varicocele. Moreover, different varicocele correction techniques are associated with varying recurrence rates. The higher rates of varicocele recurrence are observed with macroscopic inguinal or subinguinal varicocelectomy, which is theorized to be secondary to missed smaller internal spermatic veins that later dilate and cause recurrence. Recurrences after the open retroperitoneal or laparoscopic varicocele corrections are often attributed to the inability to ligate external gonadal (cremasteric) vessels or the external spermatic veins. Correction of varicocele recurrence is indicated for patients who remain infertile or symptomatic after the initial surgery. The best management for patients with recurrent varicocele is under debate. Surgical correction can be performed with open varicocelectomy, laparoscopic varicocelectomy, or embolization; however, the lack of randomized clinical trials comparing the outcomes of these different techniques hampers our ability to recognize the most effective treatment option.

Keywords

Recurrent varicocele Infertility Varicocelectomy Semen Sclerotherapy Embolization 

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Authors and Affiliations

  1. 1.Department of Surgery, Urology SectionUniversity of CataniaCataniaItaly
  2. 2.Department of UrologyBahceci Health GroupIstanbulTurkey

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