About this Research Topic
Varicocele is a disease affecting the vascular system of the testicle, characterized by the dilatation and incontinence of the testicular veins (more precisely of the pampiniform plexus), which have the role of draining the blood from the testicle. This is particularly evident in the left testicle in 95% of cases, and occurs rarely in the right testicle due to different anatomical characteristics between the two vascular pathways.
Varicocele is quite common, with cases most commonly occurring in young men aged between 10 and 19 years old. It is also present in 30-40% of men presenting with infertility. In most cases, the disease does not show clinical symptoms, but can lead to testicular hypotrophy and consequently to hypotestosteronemia.
The real need to surgically correct varicocele remains a topic of great debate in the scientific community today, but thanks to recent published meta-analyses, there has been greater clarity on the indications to be followed, so much so that even the guidelines of the main international companies have started to provide more precise indications for clinical practice.
The correction modality can be different and there are advantages and disadvantages for each technique of both conventional surgery and interventional radiology. The current gold standard treatment is the subinguinal microsurgical varicocelectomy. This approach secures the anatomical preservation of testicular arteries and lymph vessels. In addition, the subinguinal magnified approach allows ligation of not only the pampiniform plexus-internal spermatic vein drainage system but also that of the cremasterium-external spermatic vein venous drainage system. On the other hand, the radiological approach represents a non-invasive treatment with relatively low cost. However, the presence of important anatomical variants (in 7% of cases) of the veno-spermatic district contraindicate the radiological treatment, with the classical surgical techniques being preferred in these cases. These techniques, if performed by expert operators, offer good results; however, international guidelines report that the risk of varicocele’s recurrence or persistence should be considered. Finally, there is no absolutely conclusive and robust data on the real advantage that can be derived from the correction of the varicocele on the patient's state of fertility and, in particular, on the impact that it can derive in terms of pregnancy rate and live birth rate. On the other hand, Kroese and co-workers (2013) have concluded that surgical or radiological treatment of varicocele in subfertile men with a clinically manifest varicocele and poor semen quality may be of benefit. For every seven men treated, one additional pregnancy will be obtained. Developments of a varicocele model in the rat, rabbit, dog or monkey have also confirmed the beneficial effect of surgical varicocelectomy on testicular endocrine and exocrine function and male reproductive potential.
Varicocele is one of the main causes of infertility in men, although the precise pathophysiological correlation is still not fully understood. Several theories have been proposed, but none have yet been declared as the most probable. From a clinical standpoint, the data emerging from meta-analysis studies is that the correction of varicocele in infertile subjects increases the patient's chances of fertility, mainly related to an overall improvement in the seminal parameters. However, the data relating to the impact that the varicocelectomy can have on the live birth rate is still not very solid.
This Research Topic aims to explore the current and most-critically analyzed data on the clinical management and correction of varicocele, in order to guide physicians toward the best clinical choice relating to the patient’s specific needs with the aim of improving fertility and cosmetic outcomes.
Keywords: varicocele, infertility, semen analysis, reproduction, live birth rate, varicocelectomy, radiology
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