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Varicocele and Male Infertility pp 505–514Cite as

Should Varicoceles Be Managed Surgically or Radiographically? (Surgery)

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Abstract

Varicocele treatment has existed for over a century, and numerous surgical and radiographic treatment options exist. All available treatments provide reasonable improvements in clinical outcomes for the infertile male, although certain treatment choices may be preferred in unique patient populations or specific clinical situations. However, a clear difference exists among treatment methods regarding complication and recurrence rates, with microsurgical inguinal or subinguinal varicocelectomy using intraoperative Doppler assistance providing superior outcomes. Yet, recurrent varicoceles may be preferentially treated with a radiographic approach in certain situations. In the end, surgical treatment may provide a more overall cost-effective approach than radiographic embolization in the treatment of varicocele-related male infertility.

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References

  1. Noske HD, Weidner W. Varicocele--a historical perspective. World J Urol. 1999;17(3):151–7.

    Article  CAS  PubMed  Google Scholar 

  2. Palomo A. Radical cure of varicocele by a new technique; preliminary report. J Urol. 1949;61(3):604–7.

    Article  CAS  PubMed  Google Scholar 

  3. Tulloch WS. Varicocele in subfertility; results of treatment. Br Med J. 1955;2(4935):356–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lima SS, Castro MP, Costa OF. A new method for the treatment of varicocele. Andrologia. 1978;10(2):103–6.

    Article  CAS  PubMed  Google Scholar 

  5. Silber SJ. Microsurgical aspects of varicocele. Fertil Steril. 1979;31(2):230–2.

    Article  CAS  PubMed  Google Scholar 

  6. Marmar JL, DeBenedictis TJ, Praiss D. The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertil Steril. 1985;43(4):583–8.

    Article  CAS  PubMed  Google Scholar 

  7. Hagood PG, Mehan DJ, Worischeck JH, Andrus CH, Parra RO. Laparoscopic varicocelectomy: preliminary report of a new technique. J Urol. 1992;147(1):73–6.

    Article  CAS  PubMed  Google Scholar 

  8. Cayan S, Shavakhabov S, Kadioglu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 2009;30(1):33–40. https://doi.org/10.2164/jandrol.108.005967.

    Article  PubMed  Google Scholar 

  9. Cassidy D, Jarvi K, Grober E, Lo K. Varicocele surgery or embolization: Which is better? Can Urol Assoc J. 2012;6(4):266–8. https://doi.org/10.5489/cuaj.11064.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cayan S, Acar D, Ulger S, Akbay E. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J Urol. 2005;174(5):2003–6.; discussion 6-7. https://doi.org/10.1097/01.ju.0000176488.44895.7b.

    Article  PubMed  Google Scholar 

  11. Gontero P, Pretti G, Fontana F, Zitella A, Marchioro G, Frea B. Inguinal versus subinguinal varicocele vein ligation using magnifying loupe under local anesthesia: which technique is preferable in clinical practice? Urology. 2005;66(5):1075–9. https://doi.org/10.1016/j.urology.2005.05.009.

    Article  PubMed  Google Scholar 

  12. Silveri M, Adorisio O, Pane A, Colajacomo M, De Gennaro M. Subinguinal microsurgical ligation--its effectiveness in pediatric and adolescent varicocele. Scand J Urol Nephrol. 2003;37(1):53–4. https://doi.org/10.1080/00365590310008703.

    Article  CAS  PubMed  Google Scholar 

  13. Guo L, Sun W, Shao G, Song H, Ge N, Zhao S, et al. Outcomes of microscopic subinguinal varicocelectomy with and without the assistance of doppler ultrasound: a randomized clinical trial. Urology. 2015;86(5):922–8. https://doi.org/10.1016/j.urology.2015.08.002.

    Article  PubMed  Google Scholar 

  14. Pessaux P, Lermite E, Blezel E, Msika S, Hay JM, Flamant Y, et al. Predictive risk score for infection after inguinal hernia repair. Am J Surg. 2006;192(2):165–71. https://doi.org/10.1016/j.amjsurg.2006.05.003.

    Article  PubMed  Google Scholar 

  15. Pham KN, Sandlow JI. The effect of body mass index on the outcomes of varicocelectomy. J Urol. 2012;187(1):219–21. https://doi.org/10.1016/j.juro.2011.09.033.

    Article  PubMed  Google Scholar 

  16. McGrath TM, Farabaugh EA, Pickett MJ, Wagner DK, Griswold-Theodorson S. Obesity hinders ultrasound visualization of the subclavian vein: implications for central venous access. J Vasc Access. 2012;13(2):246–50. https://doi.org/10.5301/jva.5000051.

    Article  PubMed  Google Scholar 

  17. Cox N, Resnic FS, Popma JJ, Simon DI, Eisenhauer AC, Rogers C. Comparison of the risk of vascular complications associated with femoral and radial access coronary catheterization procedures in obese versus nonobese patients. Am J Cardiol. 2004;94(9):1174–7. https://doi.org/10.1016/j.amjcard.2004.07.088.

    Article  PubMed  Google Scholar 

  18. Pastuszak AW, Kumar V, Shah A, Roth DR. Diagnostic and management approaches to pediatric and adolescent varicocele: a survey of pediatric urologists. Urology. 2014;84(2):450–5. https://doi.org/10.1016/j.urology.2014.04.022.

    Article  PubMed  Google Scholar 

  19. Hassan JM, Adams MC, JCt P, Demarco RT, Brock JW 3rd. Hydrocele formation following laparoscopic varicocelectomy. J Urol. 2006;175(3 Pt 1):1076–9. https://doi.org/10.1016/S0022-5347(05)00402-7.

    Article  PubMed  Google Scholar 

  20. Yaman O, Soygur T, Zumrutbas AE, Resorlu B. Results of microsurgical subinguinal varicocelectomy in children and adolescents. Urology. 2006;68(2):410–2. https://doi.org/10.1016/j.urology.2006.02.022.

    Article  PubMed  Google Scholar 

  21. VanderBrink BA, Palmer LS, Gitlin J, Levitt SB, Franco I. Lymphatic-sparing laparoscopic varicocelectomy versus microscopic varicocelectomy: is there a difference? Urology. 2007;70(6):1207–10. https://doi.org/10.1016/j.urology.2007.09.036.

    Article  PubMed  Google Scholar 

  22. Glassberg KI, Poon SA, Gjertson CK, DeCastro GJ, Misseri R. Laparoscopic lymphatic sparing varicocelectomy in adolescents. J Urol. 2008;180(1):326–30discussion 30-1. https://doi.org/10.1016/j.juro.2008.03.064.

    Article  PubMed  Google Scholar 

  23. Storm DW, Hogan MJ, Jayanthi VR. Initial experience with percutaneous selective embolization: A truly minimally invasive treatment of the adolescent varicocele with no risk of hydrocele development. J Pediatr Urol. 2010;6(6):567–71. https://doi.org/10.1016/j.jpurol.2010.01.003.

    Article  PubMed  Google Scholar 

  24. Fayad F, Sellier N, Chabaud M, Kazandjian V, Larroquet M, Raquillet C, et al. Percutaneous retrograde endovascular occlusion for pediatric varicocele. J Pediatr Surg. 2011;46(3):525–9. https://doi.org/10.1016/j.jpedsurg.2010.08.014.

    Article  PubMed  Google Scholar 

  25. Malekzadeh S, Fraga-Silva RA, Morere PH, Sorega A, Produit S, Stergiopulos N, et al. Varicocele percutaneous embolization outcomes in a pediatric group: 7-year retrospective study. Int Urol Nephrol. 2016;48(9):1395–9. https://doi.org/10.1007/s11255-016-1340-x.

    Article  CAS  PubMed  Google Scholar 

  26. Baigorri BF, Dixon RG. Varicocele: a review. Semin Intervent Radiol. 2016;33(3):170–6. https://doi.org/10.1055/s-0036-1586147.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Evers JH, Collins J, Clarke J. Surgery or embolisation for varicoceles in subfertile men. Cochrane Database Syst Rev. 2008;(3):CD000479. https://doi.org/10.1002/14651858.CD000479.pub3.

  28. Schauer I, Madersbacher S, Jost R, Hubner WA, Imhof M. The impact of varicocelectomy on sperm parameters: a meta-analysis. J Urol. 2012;187(5):1540–7. https://doi.org/10.1016/j.juro.2011.12.084.

    Article  PubMed  Google Scholar 

  29. Baazeem A, Belzile E, Ciampi A, Dohle G, Jarvi K, Salonia A, et al. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol. 2011;60(4):796–808. https://doi.org/10.1016/j.eururo.2011.06.018.

    Article  PubMed  Google Scholar 

  30. Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Sabanegh E, et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology. 2007;70(3):532–8. https://doi.org/10.1016/j.urology.2007.04.011.

    Article  PubMed  Google Scholar 

  31. Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM. Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Eur Urol. 2011;59(3):455–61. https://doi.org/10.1016/j.eururo.2010.12.008.

    Article  PubMed  Google Scholar 

  32. Bou Nasr E, Binhazzaa M, Almont T, Rischmann P, Soulie M, Huyghe E. Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: prospective comparison of reproductive and functional outcomes. Basic and clinical andrology. 2017;27:11. https://doi.org/10.1186/s12610-017-0055-x.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shridharani A, Lockwood G, Sandlow J. Varicocelectomy in the treatment of testicular pain: a review. Curr Opin Urol. 2012;22(6):499–506. https://doi.org/10.1097/MOU.0b013e328358f69f.

    Article  PubMed  Google Scholar 

  34. Puche-Sanz I, Flores-Martin JF, Vazquez-Alonso F, Pardo-Moreno PL, Cozar-Olmo JM. Primary treatment of painful varicocoele through percutaneous retrograde embolization with fibred coils. Andrology. 2014;2(5):716–20. https://doi.org/10.1111/j.2047-2927.2014.00253.x.

    Article  CAS  PubMed  Google Scholar 

  35. Ghanem H, Anis T, El-Nashar A, Shamloul R. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Urology. 2004;64(5):1005–9. https://doi.org/10.1016/j.urology.2004.06.060.

    Article  CAS  PubMed  Google Scholar 

  36. Shiraishi K, Oka S, Ito H, Matsuyama H. Comparison of the results and complications of retroperitoneal, microsurgical subinguinal, and high inguinal approaches in the treatment of varicoceles. J Androl. 2012;33(6):1387–93. https://doi.org/10.2164/jandrol.112.016444.

    Article  PubMed  Google Scholar 

  37. Watanabe M, Nagai A, Kusumi N, Tsuboi H, Nasu Y, Kumon H. Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches. International journal of urology: official journal of the Japanese Urological Association. 2005;12(10):892–8. https://doi.org/10.1111/j.1442-2042.2005.01142.x.

    Article  Google Scholar 

  38. Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology. 2000;55(5):750–4.

    Article  CAS  PubMed  Google Scholar 

  39. Wang J, Xia SJ, Liu ZH, Tao L, Ge JF, Xu CM, et al. Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis. Asian J Androl. 2015;17(1):74–80. https://doi.org/10.4103/1008-682x.136443.

    Article  PubMed  Google Scholar 

  40. Hopps CV, Lemer ML, Schlegel PN, Goldstein M. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol. 2003;170(6. Pt 1):2366–70. https://doi.org/10.1097/01.ju.0000097400.67715.f8.

    Article  PubMed  Google Scholar 

  41. Shiraishi K, Oka S, Matsuyama H. Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele. International journal of urology: official journal of the Japanese Urological Association. 2016;23(4):338–42. https://doi.org/10.1111/iju.13050.

    Article  Google Scholar 

  42. Orhan I, Onur R, Semercioz A, Firdolas F, Ardicoglu A, Koksal IT. Comparison of two different microsurgical methods in the treatment of varicocele. Arch Androl. 2005;51(3):213–20.

    Article  CAS  PubMed  Google Scholar 

  43. Johnson D, Sandlow J. Treatment of varicoceles: techniques and outcomes. Fertil Steril. 2017;108(3):378–84. https://doi.org/10.1016/j.fertnstert.2017.07.020.

    Article  PubMed  Google Scholar 

  44. Halpern J, Mittal S, Pereira K, Bhatia S, Ramasamy R. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl. 2016;18(2):234–8. https://doi.org/10.4103/1008-682x.169985.

    Article  PubMed  Google Scholar 

  45. Gandini R, Konda D, Reale CA, Pampana E, Maresca L, Spinelli A, et al. Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate--outcome in 244 patients. Radiology. 2008;246(2):612–8. https://doi.org/10.1148/radiol.2462061295.

    Article  PubMed  Google Scholar 

  46. Gazzera C, Rampado O, Savio L, Di Bisceglie C, Manieri C, Gandini G. Radiological treatment of male varicocele: technical, clinical, seminal and dosimetric aspects. Radiol Med. 2006;111(3):449–58. https://doi.org/10.1007/s11547-006-0041-4.

    Article  CAS  PubMed  Google Scholar 

  47. Urbano J, Cabrera M, Alonso-Burgos A. Sclerosis and varicocele embolization with N-butyl cyanoacrylate: experience in 41 patients. Acta radiologica (Stockholm, Sweden: 1987). 2014;55(2):179–85. https://doi.org/10.1177/0284185113493774.

    Article  Google Scholar 

  48. Seyferth W, Jecht E, Zeitler E. Percutaneous sclerotherapy of varicocele. Radiology. 1981;139(2):335–40. https://doi.org/10.1148/radiology.139.2.7220877.

    Article  CAS  PubMed  Google Scholar 

  49. Iaccarino V, Venetucci P. Interventional radiology of male varicocele: current status. Cardiovasc Intervent Radiol. 2012;35(6):1263–80. https://doi.org/10.1007/s00270-012-0350-z.

    Article  PubMed  Google Scholar 

  50. Chomyn JJ, Craven WM, Groves BM, Durham JD. Percutaneous removal of a Gianturco coil from the pulmonary artery with use of flexible intravascular forceps. J Vascul Inter Radiol: JVIR. 1991;2(1):105–6.

    Article  CAS  Google Scholar 

  51. Sivanathan C, Abernethy LJ. Retrograde embolisation of varicocele in the paediatric age group: a review of 10 years’ practice. Ann R Coll Surg Engl. 2003;85(1):50–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Boscolo-Berto R, Macchi V, Porzionato A, Morra A, Vezzaro R, Loukas M, et al. Ischemic colitis following left antegrade sclerotherapy for idiopathic varicocele. Clin Anatomy (New York, NY). 2018;31:774. https://doi.org/10.1002/ca.23066.

    Article  Google Scholar 

  53. Vicini P, Di Pierro GB, Grande P, Voria G, Antonini G, De Marco F, et al. Large bowel infarct following antegrade scrotal sclerotherapy for varicocele: A case report. Can Urol Assoc J. 2014;8(9–10):E641–3. https://doi.org/10.5489/cuaj.1822.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Jargiello T, Drelich-Zbroja A, Falkowski A, Sojka M, Pyra K, Szczerbo-Trojanowska M. Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure. Acta Radiologica (Stockholm, Sweden: 1987). 2015;56(1):63–9. https://doi.org/10.1177/0284185113519624.

    Article  Google Scholar 

  55. Rotker K, Sigman M. Recurrent varicocele. Asian J Androl. 2016;18(2):229–33. https://doi.org/10.4103/1008-682x.171578.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Grober ED, Chan PT, Zini A, Goldstein M. Microsurgical treatment of persistent or recurrent varicocele. Fertil Steril. 2004;82(3):718–22. https://doi.org/10.1016/j.fertnstert.2004.03.028.

    Article  PubMed  Google Scholar 

  57. Chawla A, Kulkarni G, Kamal K, Zini A. Microsurgical varicocelectomy for recurrent or persistent varicoceles associated with orchalgia. Urology. 2005;66(5):1072–4. https://doi.org/10.1016/j.urology.2005.05.052.

    Article  PubMed  Google Scholar 

  58. Rais-Bahrami S, Montag S, George AK, Rastinehad AR, Palmer LS, Siegel DN. Angiographic findings of primary versus salvage varicoceles treated with selective gonadal vein embolization: an explanation for surgical treatment failure. J Endourol. 2012;26(5):556–60. https://doi.org/10.1089/end.2011.0387.

    Article  PubMed  Google Scholar 

  59. Kim J, Shin JH, Yoon HK, Ko GY, Gwon DI, Kim EY, et al. Persistent or recurrent varicocoele after failed varicocoelectomy: outcome in patients treated using percutaneous transcatheter embolization. Clin Radiol. 2012;67(4):359–65. https://doi.org/10.1016/j.crad.2011.10.007.

    Article  CAS  PubMed  Google Scholar 

  60. Mazzoni G, Minucci S, Gentile V. Recurrent varicocele: role of antegrade sclerotherapy as first choice treatment. Eur Urol. 2002;41(6):614–8.. discussion 8

    Article  CAS  PubMed  Google Scholar 

  61. Punekar SV, Prem AR, Ridhorkar VR, Deshmukh HL, Kelkar AR. Post-surgical recurrent varicocele: efficacy of internal spermatic venography and steel-coil embolization. Br J Urol. 1996;77(1):124–8.

    Article  CAS  PubMed  Google Scholar 

  62. Johnsen N, Tauber R. Financial analysis of antegrade scrotal sclerotherapy for men with varicoceles. Br J Urol. 1996;77(1):129–32.

    Article  CAS  PubMed  Google Scholar 

  63. Abdulmaaboud MR, Shokeir AA, Farage Y, Abd El-Rahman A, El-Rakhawy MM, Mutabagani H. Treatment of varicocele: a comparative study of conventional open surgery, percutaneous retrograde sclerotherapy, and laparoscopy. Urology. 1998;52(2):294–300.

    Article  CAS  PubMed  Google Scholar 

  64. Kovac JR, Fantus J, Lipshultz LI, Fischer MA, Klinghoffer Z. Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility. Can Urol Assoc J. 2014;8(9–10):E619–25. https://doi.org/10.5489/cuaj.1873.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA

    J. Abram McBride, Daniel J. Mazur & Larry I. Lipshultz

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  1. J. Abram McBride
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  2. Daniel J. Mazur
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  3. Larry I. Lipshultz
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Correspondence to Larry I. Lipshultz .

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Editors and Affiliations

  1. ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, São Paulo, Brazil

    Sandro C Esteves

  2. S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Chak-Lam Cho

  3. Department of Urology, Hamad Medical Corporation, Weill Cornell Medicine Qatar, Doha, Qatar

    Ahmad Majzoub

  4. Department of Urology, Cleveland Clinic, Cleveland, OH, USA

    Ashok Agarwal

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McBride, J.A., Mazur, D.J., Lipshultz, L.I. (2019). Should Varicoceles Be Managed Surgically or Radiographically? (Surgery). In: Esteves, S., Cho, CL., Majzoub, A., Agarwal, A. (eds) Varicocele and Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-79102-9_46

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