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Is Varicocele a Bilateral Disease?

  • Peter Ka-Fung Chiu
  • Chak-Lam Cho
Chapter

Abstract

While varicocele is considered to be a predominantly left-sided disease in 90% cases, the existence and implication of a contralateral varicocele over the right side, whether low grade or subclinical, are being largely overlooked. The concept of unilateral left varicocele exerting influence only on the ipsilateral testis could not sufficiently explain the overall decline in fertility as observed in infertile patients with varicocele. The lack of efficacy after varicocele repair in a significant number of patients represents another pitfall in the current practice. The deleterious effect of a left varicocele over the right testis has been shown in the absence of a varicocele over the right side. In addition, the high prevalence of a concomitant low-grade or subclinical right varicoceles in the presence of a clinical left varicocele represents another piece of evidence supporting the notion that varicocele may be a bilateral disease. Moreover, bilateral varicocelectomy resulted in better improvement in semen parameters in patients with clinical varicocele on one side with a contralateral low-grade or subclinical varicocele compared to unilateral varicocele repair. Although the conceptualization of varicocele as a bilateral disease seems reasonable, large-scale well-designed studies are eagerly required to further validate this hypothesis.

Keywords

Infertility Male Subclinical varicocele Bilateral varicocele Varicocelectomy Varicocele Pathophysiology 

References

  1. 1.
    Baazeem A, Belzile E, Ciampi A, Dohle G, Jarvi K, Salonia A, Weidner W, Zini A. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol. 2011;60:796–808.CrossRefGoogle Scholar
  2. 2.
    McDougal WS, Wein AJ, Kavoussi LR, Partin A, Peters AG. Campbell-Walsh urology. 11th ed. Philadelphia: Elsevier Saunders; 2016. p. 146.Google Scholar
  3. 3.
    American Urological Association Education and Research, Inc. Report on varicocele and infertility: an AUA Best Practice Policy and ASRM Practice Committee Report. American Urological Association, Inc; Birmingham: American Society for Reproductive Medicine; 2001.Google Scholar
  4. 4.
    Lee PA, Coughlin MT. The single testis: paternity after presentation as unilateral cryptorchidism. J Urol. 2002;168(4):1680–2.CrossRefGoogle Scholar
  5. 5.
    Gat Y, Bachar GN, Zukerman Z, Belenky A, Gornish M. Varicocele: a bilateral disease. Fertil Steril. 2004;81:424–9.CrossRefGoogle Scholar
  6. 6.
    McClure RD, Hricak H. Scrotal ultrasound in the infertile man: detection of subclinical unilateral and bilateral varicoceles. J Urol. 1986;135:711–5.CrossRefGoogle Scholar
  7. 7.
    Sun XL, Wang JL, Peng YP, Gao QQ, Song T, Yu W, Xu ZP, Chen Y, Dai YT. Bilateral is superior to unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: a prospective randomized controlled study. Int Urol Nephrol. 2018;50(2):205–10.CrossRefGoogle Scholar
  8. 8.
    Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. 1970;21(8):606–9.CrossRefGoogle Scholar
  9. 9.
    Dubin L, Hotchkiss RS. Testis biopsy in subfertile men with varicocele. Fertil Steril. 1969;20:51–7.CrossRefGoogle Scholar
  10. 10.
    Saleh R, Mahfouz RZ, Agarwal A, Farouk H. Histopathologic patterns of testicular biopsies in infertile azoospermic men with varicocele. Fertil Steril. 2010;94(6):2482–5, 5.e1-2.CrossRefGoogle Scholar
  11. 11.
    Akbay E, Cayan S, Doruk E, Duce MN, Bozlu M. The prevalence of varicocele and varicocele related testicular atrophy in Turkish children and adolescents. BJU Int. 2000;86:490–3.CrossRefGoogle Scholar
  12. 12.
    Pfeiffer D, Berger J, Schoop C, Tauber R. A Doppler-based study on the prevalence of varicocele in German children and adolescents. Andrologia. 2006;38:13–9.CrossRefGoogle Scholar
  13. 13.
    Woldu S, Nees S, Van Batavia J, Spencer B, Glassberg K. Physical exam and ultrasound characteristics of right varicocoeles in adolescents with left varicocoeles. Andrology. 2013;1(6):936–42.CrossRefGoogle Scholar
  14. 14.
    Yamamoto M, Hibi H, Hirata Y, Miyake K, Ishigaki T. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. J Urol. 1996;155(5):1636–8.CrossRefGoogle Scholar
  15. 15.
    Unal D, Yeni E, Verit A, Karatas OF. Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: a prospective randomized study. Int J Urol. 2001;8(5):227–30.CrossRefGoogle Scholar
  16. 16.
    Kohn TP, Ohlander SJ, Jacob JS, Griffin TM, Lipshultz LI, Pastuszak AW. The effect of subclinical varicocele on pregnancy rates and semen parameters: a systematic review and meta-analysis. Curr Urol Rep. 2018;19(7):53.CrossRefGoogle Scholar
  17. 17.
    Cervellione RM, Corroppolo M, Bianchi A. Subclinical varicocele in the pediatric age group. J Urol. 2008;179:717–9.CrossRefGoogle Scholar
  18. 18.
    Zampieri N, Dall’Agnola A. Subclinical varicocele and sports: a longitudinal study. Urology. 2011;77:1199–202.CrossRefGoogle Scholar
  19. 19.
    Amelar RD, Dubin L. Right varicocelectomy in selected infertile patients who have failed to improve after previous left varicocelectomy. Fertil Steril. 1987;47(5):833–7.CrossRefGoogle Scholar
  20. 20.
    Lemack GE, Uzzo RG, Schlegel PN, Goldstein M. Microsurgical repair of the adolescent varicocele. J Urol. 1998;160:179–81.CrossRefGoogle Scholar
  21. 21.
    Scherr D, Goldstein M. Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles. J Urol. 1999;162:85–8.CrossRefGoogle Scholar
  22. 22.
    Libman J, Jarvi K, Lo K, Zini A. Beneficial effect of microsurgical varicocelectomy is superior for men with bilateral versus unilateral repair. J Urol. 2006;176:2602–5.CrossRefGoogle Scholar
  23. 23.
    Baazeem A, Boman JM, Libman J, Jarvi K, Zini A. Microsurgical varicocelectomy for infertile men with oligospermia: differential effect of bilateral and unilateral varicocele on pregnancy outcomes. BJU Int. 2009;104:524–8.CrossRefGoogle Scholar
  24. 24.
    Elbendary MA, Elbadry AM. Right subclinical varicocele: how to manage in infertile patients with clinical left varicocele? Fertil Steril. 2009;92(6):2050–3.CrossRefGoogle Scholar
  25. 25.
    Zheng YQ, Gao X, Li ZJ, Yu YL, Zhang ZG, Li W. Efficacy of bilateral and left varicocelectomy in infertile men with left clinical and right subclinical varicoceles: a comparative study. Urology. 2009;73(6):1236–40.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Peter Ka-Fung Chiu
    • 1
  • Chak-Lam Cho
    • 2
  1. 1.Division of Urology, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong KongShatinHong Kong
  2. 2.S.H. Ho Urology Centre, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong KongShatinHong Kong

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