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Adult varicocele

Kim, Howard Ha,b; Goldstein, Marca,b

doi: 10.1097/MOU.0b013e3283136493
Andrology, sexual dysfunction and infertility: Edited by Peter N Schlegel

Purpose of review: Adult varicocele presents a challenge for male reproductive specialists. We have yet to fully elucidate the pathophysiology of varicocele. The enigma of the varicocele, although a source of frustration for clinicians, has been a siren call for researchers as attested to by the substantial, if flawed body of literature on the topic. We critically review recent publications on varicocele.

Recent findings: Although yielding mixed results, studies this year have explored the potential relationship between oxidative stress and varicocele-associated infertility. In clinically focused research, one group tackled the contentious question of efficacy of surgical varicocele management. Building on the errors of prior meta-analyses, this study takes a fresh view on an old but vital topic. Finally, it is becoming clearer that varicocele affects Leydig cell function as well as seminiferous tubular function, and is a risk factor for androgen deficiency.

Summary: With exceptions, recent studies support a role for varicocelectomy in the management of infertile couples. In addition, evidence is accumulating that early repair of varicoceles, especially large varicoceles, may be effective in preventing future infertility and may be an effective treatment for androgen deficiency.

aDepartment of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College, USA

bThe Population Council at Rockefeller University, New York, New York, USA

Correspondence to Marc Goldstein MD, DSc (hon), FACS, Matthew P. Hardy Distinguished Professor of Reproductive Medicine, and Urology, Senior Scientist, Population Council, Surgeon-in-Chief, Male Reproductive Medicine and Surgery, Cornell Institute for Reproductive Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 580, New York, NY 10065, USA Tel: +1 212 746 5470; fax: +1 212 746 0977; e-mail: mgoldst@med.cornell.edu

© 2008 Lippincott Williams & Wilkins, Inc.