Debated Issues on Varicocele Repair

Widi Atmoko

Bartholin cyst, Bartholin duct, marsupialization, Word catheter

The video covers on the discussion of debated issues of varicocele, which serves ad the most common correctable causes of male infertility. Currently there is a wide diversity in the approach to varicocele diagnosis and management, suggesting the lack of consensus and
disagreement among professional societies. For diagnosis, ultrasonography can be used as an adjuvant diagnostic modality, it should not be used routinely in diagnosing varicocele.

However, there is a lack of consensus on the threshold values and some surgeons still routinely use USG routinely. This could result in over-diagnosis, unnecessary surgeries, and/or confusion. Additionally, although the deleterious effect on testicular function, including sperm DNA fragmentation and oxidative stress has been confirmed, no clear recommendation whether these parameters should be tested in every man with varicocele. Other crucial aspect is to know which patient would benefit the most from varicocelectomy and what indication varicocele repair should be done. The dilemma is whether varicocele treatment is indicated in men with raised DNA fragmentation, subclinical right varicocele, and hypogonadism. Moreover, EAU and AUA guidelines even have contradicting recommendation for varicocelectomy in men with non-obstructive azoospermia. Therefore, a detailed discussion of the prognosis and tailored management should always be done whenever varicocelectomy is offered. The primary goal of varicocelectomy is to prevent reflux in the internal spermatic vein while leaving the internal spermatic artery, lymphatics, and vas deferens intact. Varicocele repair has been advocated using a variety of operative and non-operative techniques. While no RCT is available, current evidence suggests that microscopic approaches may have higher efficacy and lower complications. After the procedure, patients are expected to avoid any significant exertion for 12 weeks and start repeat sperm analysis after 3-6 months. In cases of recurrent varicocele, there is no established standard technique. However, different approaches are typically employed compared to the initial procedure.

None.

The authors have nothing to disclose

1. Alsaikhan B, Alrabeeah K, Delouya G, et al. Epidemiology of varicocele. Asian J Androl

2016; 18(2):179–81

2. Chiba K, Ramasamy R, Lamb DJ, Lipshultz LI. The varicocele: diagnostic dilemmas,

therapeutic challenges and future perspectives. Asian J Androl. 2016 Mar-Apr;18(2):276- 81.

3. Salonia A, Bettocchi C, Carvalho J, Corona G, et al. EAU guidelines on sexual and

reproductive health. Arnhem: EAU;2022

4. Shah R, Agarwal A, Kavoussi P, Rambhatla A, Saleh R, et al. Consensus and Diversity in

the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and

Comparison with Guidelines and Recommendations. World J Mens Health. 2022 Jun 13.

5. Tatem AJ, Brannigan RE. The role of microsurgical varicocelectomy in treating male infertility.

Transl Androl Urol. 2017 Aug;6(4):722-729