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Varicocele and Male Infertility pp 565–571Cite as

Recurrent Grade 2/3 Varicocele After Microsurgical Varicocelectomy and Abnormal Semen Parameters in a Couple Attempting Conception for >3 Years

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Abstract

This book chapter is about the clinical scenario of a recurrent grade 2 or 3 varicocele after microsurgical varicocelectomy and abnormal semen parameters in a couple attempting conception for more than 3 years. This case scenario highlights a possible critical role for the internal spermatic vein reflux or a left-to-right venous communication system, situated superficially as well as in the deep drainage system. Inguinal and subinguinal microscopic varicocelectomy is the optimal management of varicocele mainly because it had the best outcomes with significant increase in semen parameters, the highest pregnancy rates with low rates of complication, including recurrence. The overall recurrence rate of microsurgical approach, including subinguinal and inguinal techniques, varies from 0% to 3.57%. Few studies evaluating the treatment of recurrent grade 2 or 3 varicocele after microsurgery are available, and they are usually uncontrolled, just representing a small part of a heterogeneous population. Based on the best evidence available, choosing an optimal method for treatment of proposed scenario is not possible, and randomized controlled trials must be done to clarify these questions. Therefore, author’s suggestion is to redo microsurgical varicocelectomy, using an intraoperative Doppler ultrasound, with an incision as low as possible.

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Author information

Authors and Affiliations

  1. Androscience – Science and Innovation Center and High-Complexity Clinical and Research Andrology Laboratory, Sao Paulo, Brazil

    Jorge Hallak, João Arthur Brunhara & Thiago Afonso Teixeira

  2. Men’s Health Study Group, Institute for Advanced Studies, Division of Urology, Reproductive Toxicology Unit, Department of Pathology, University of São Paulo, Sao Paulo, Brazil

    Jorge Hallak

  3. Men’s Health Study Group, Institute for Advanced Studies, Division of Urology, University of Sao Paulo, Sao Paulo, Brazil

    João Arthur Brunhara & Thiago Afonso Teixeira

  4. School of Medicine, Federal University of Amapa, Macapa, Brazil

    Thiago Afonso Teixeira

Authors
  1. Jorge Hallak
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  2. João Arthur Brunhara
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  3. Thiago Afonso Teixeira
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Corresponding author

Correspondence to Jorge Hallak .

Editor information

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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Hallak, J., Brunhara, J.A., Teixeira, T.A. (2019). Recurrent Grade 2/3 Varicocele After Microsurgical Varicocelectomy and Abnormal Semen Parameters in a Couple Attempting Conception for >3 Years. 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_53

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  • DOI: https://doi.org/10.1007/978-3-319-79102-9_53

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-79101-2

  • Online ISBN: 978-3-319-79102-9

  • eBook Packages: MedicineMedicine (R0)

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