Skip to main content
SpringerLink
Log in

Treating varicocele in 2018: current knowledge and treatment options

  • Review
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects.

Methods

We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: “varicocele”, “varicocelectomy”, “sclerotherapy”, “male infertility”, “subfertility”, and “semen abnormalities”.

Results

Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach.

Conclusions

Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Di Bisceglie C, Fornengo R, Grosso M, Gazzera C, Mancini A, Andriani B, Lanfranco F, Brocato L, Gandini G, Manieri C (2003) Follow-up of varicocele treated with percutaneous retrograde sclerotherapy: technical, clinical and seminal aspects. J Endocrinol Invest 26(11):1059–1064

    PubMed  Google Scholar 

  2. Vanlangenhove P, Dhondt E, Everaert K, Defreyne L (2014) Pathophysiology, diagnosis and treatment of varicoceles: a review. Minerva Urol Nefrol 66(4):257–282

    CAS  PubMed  Google Scholar 

  3. Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Sabanegh E, Marmar JL (2007) Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology 70(3):532–538

    PubMed  Google Scholar 

  4. Saypol DC (1981) Varicocele. J Androl 2:61–71

    Google Scholar 

  5. Clavijo RI, Carrasquillo R, Ramasamy R (2017) Varicoceles: prevalence and pathogenesis in adult men. Fertil Steril 108(3):364–369

    PubMed  Google Scholar 

  6. Comhaire F, Kunnen M, Nahoum C (1981) Radiological anatomy of the internal spermatic vein(s) in 200 retrograde venograms. Int J Androl 4:379–387

    CAS  PubMed  Google Scholar 

  7. De Schepper A (1972) “Nutcracker” phenomenon of the renal vein and venous pathology of the left kidney. J Belge Radiol 55:507–511

    PubMed  Google Scholar 

  8. Akbay E, Cayan S, Doruk E, Duce MN, Bozlu M (2000) The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents. BJU Int 86:490–493

    CAS  PubMed  Google Scholar 

  9. Ozbek E, Turkoz Y, Gokdeniz R, Davarci M, Ozugurlu F (2000) Increased nitric oxide production in the spermatic vein of patients with varicocele. Eur Urol 37:172–175

    CAS  PubMed  Google Scholar 

  10. Shafik A, Khalil AM, Saleh M (1972) The fasciomuscular tube of the spermatic cord. A study of its surgical anatomy and relation to varicocele. A new concept for the pathogenesis of varicocele. Br J Urol 44:147–151

    CAS  PubMed  Google Scholar 

  11. Lomboy JR, Coward RM (2016) The varicocele: clinical presentation, evaluation, and surgical management. Semin Intervent Radiol 33(3):163–169

    PubMed  PubMed Central  Google Scholar 

  12. Paick S, Choi WS (2018) Varicocele and testicular pain: a review. World J Mens Health. https://doi.org/10.5534/wjmh.170010

    Article  PubMed  Google Scholar 

  13. Gat Y, Bachar GN, Zukerman Z, Belenky A, Gorenish M (2004) Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities. J Urol 172(4 Pt 1):1414–1417

    PubMed  Google Scholar 

  14. Will MA, Swain J, Fode M, Sonksen J, Christman GM, Ohl D (2011) The great debate: varicocele treatment and impact on fertility. Fertil Steril 95(3):841–852

    PubMed  PubMed Central  Google Scholar 

  15. Lanfranco F, Motta G (2016) Gonadal imaging in endocrine disorders. Front Horm Res 45:80–96

    PubMed  Google Scholar 

  16. Brannigan RE (2017) Introduction: varicoceles: a contemporary perspective. Fertil Steril 108(3):361–363

    PubMed  Google Scholar 

  17. Johnson D, Sandlow J (2017) Treatment of varicoceles: techniques and outcomes. Fertil Steril 108(3):378–384

    PubMed  Google Scholar 

  18. Cho C-L, Esteves SC, Agarwal A (2016) Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation. Asian J Androl 18:186–193

    CAS  PubMed  Google Scholar 

  19. MacLeod J (1965) Seminal cytology in the presence of varicocele. Fertil Steril 16:735–757

    CAS  PubMed  Google Scholar 

  20. Naughton CK, Nangia AK, Agarwal A (2001) Pathophysiology of varicoceles in male infertility. Hum Reprod Update 7:473–481

    CAS  PubMed  Google Scholar 

  21. Agarwal A, Sharma R, Harlev A, Esteves SC (2016) Effect of varicocele on semen characteristics according to the new 2010 World Health Organization criteria: a systematic review and meta-analysis. Asian J Androl 18(2):163–170

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Ni K, Steger K, Yang H, Wang H, Hu K, Zhang T, Chen B (2016) A comprehensive investigation of sperm DNA damage and oxidative stress injury in infertile patients with subclinical, normozoospermic, and astheno/oligozoospermic clinical varicocele. Andrology 4:816–824

    CAS  PubMed  Google Scholar 

  23. Zhang Y, Ma T, Su Z, Ye M, Tian H, Li J, Liu J (2017) Varicoceles affect semen quality of infertile men in Southern China: a cross-sectional study of 5447 cases. Medicine 96(31):e7707 (Baltimore)

    PubMed  PubMed Central  Google Scholar 

  24. Pallotti F, Paoli D, Carlini T, Vestri AR, Martino G, Lenzi A, Lombardo F (2018) Varicocele and semen quality: a retrospective case-control study of 4230 patients from a single centre. J Endocrinol Invest 41:185–192

    CAS  PubMed  Google Scholar 

  25. Al-Ali BM, Marszalek M, Shamloul R, Pummer K, Trummer H (2010) Clinical parameters and semen analysis in 716 Austrian patients with varicocele. Urology 75(5):1069–1073

    PubMed  Google Scholar 

  26. Vivas-Acevedo G, Lozano JR, Camejo MI (2010) Effect of varicocele grade and age on seminal parameters. Urol Int 85(2):194–199

    PubMed  Google Scholar 

  27. Ayodeji O, Baker HW (1986) Is there a specific abnormality of sperm morphology in men with varicoceles? Fertil Steril 45:839–842

    CAS  PubMed  Google Scholar 

  28. Witt MA, Lipshultz LI (1993) Varicocele: a progressive or static lesion? Urology 42:541–543

    CAS  PubMed  Google Scholar 

  29. Lenzi A, Gandini L, Bagolan P, Nahum A, Dondero F (1998) Sperm parameters after early left varicocele treatment. Fertil Steril 69:347–349

    CAS  PubMed  Google Scholar 

  30. Moazzam A, Sharma R, Agarwal A (2015) Relationship of spermatozoal DNA fragmentation with semen quality in varicocele-positive men. Andrologia 47(8):935–944

    CAS  PubMed  Google Scholar 

  31. Zini A, Dohle G (2011) Are varicoceles associated with increased deoxyribonucleic acid fragmentation? Fertil Steril 96:1283–1287

    CAS  PubMed  Google Scholar 

  32. Jung A, Schuppe HC (2007) Influence of genital heat stress on semen quality in humans. Andrologia 39:203–215

    CAS  PubMed  Google Scholar 

  33. Garolla A, Torino M, Miola P, Caretta N, Pizzol D, Menegazzo M, Bertoldo A, Foresta C (2015) Twenty-four-hour monitoring of scrotal temperature in obese men and men with a varicocele as a mirror of spermatogenic function. Hum Reprod 30:1006–1013

    CAS  PubMed  Google Scholar 

  34. Yadav SK, Pandey A, Kumar L, Devi A, Kushwaha B, Vishvkarma R, Maikhuri JP, Rajender S, Gupta G (2018) The thermo-sensitive gene expression signatures of spermatogenesis. Reprod Biol Endocrinol 16:56

    PubMed  PubMed Central  Google Scholar 

  35. Zhang MH, Zhai LP, Fang ZY, Li AN, Qiu Y, Liu YX (2018) Impact of a mild scrotal heating on sperm chromosomal abnormality, acrosin activity and seminal alpha-glucosidase in human fertile males. Andrologia. https://doi.org/10.1111/and.12985

    Article  PubMed  Google Scholar 

  36. Agarwal A, Mulgund A, Alshahrani S, Assidi M, Abuzenadah AM, Sharma R, Sabanegh E (2014) Reactive oxygen species and sperm DNA damage in infertile men presenting with low level leukocytospermia. Reprod Biol Endocrinol 12:126–133

    PubMed  PubMed Central  Google Scholar 

  37. Erenpreiss J, Hlevicka S, Zalkalns J, Erenpreisa J (2002) Effect of leukocytospermia on sperm DNA integrity: a negative effect in abnormal semen samples. J Androl 23:717–723

    PubMed  Google Scholar 

  38. Marmar JL (2001) The pathophysiology of varicoceles in the light of current molecular and genetic information. Hum Reprod Update 7:461–472

    CAS  PubMed  Google Scholar 

  39. Lee J-D, Jeng S-Y, Lee T-H (2006) Increased expression of hypoxia-inducible factor-1a in the internal spermatic vein of patients with varicocele. J Urol 175:1045–1048

    CAS  PubMed  Google Scholar 

  40. Benoff S, Hauser R, Marmar JL, Hurley IR, Napolitano B, Centola GM (2009) Cadmium concentrations in blood and seminal plasma: correlations with sperm number and motility in three male populations (infertility patients, artificial insemination donors, and unselected volunteers). Mol Med 15:248–262

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Bronson RA, Cooper GW, Rosenfeld DL (1984) Autoimmunity to spermatozoa: effect on sperm penetration of cervical mucus as reflected by postcoital testing. Fertil Steril 41:609–614

    CAS  PubMed  Google Scholar 

  42. Cayan S, Kadioglu A, Orhan I, Kandirali E, Tefekli A, Tellaloglu S (1999) The effect of microsurgical varicocelectomy on serum follicle stimulating hormone, testosterone and free testosterone levels in infertile men with varicocele. BJU Int 84:1046–1049

    CAS  PubMed  Google Scholar 

  43. Su LM, Goldstein M, Schlegel PN (1995) The effect of varicocelectomy on serum testosterone levels in infer-tile men with varicoceles. J Urol 154:1752–1755

    CAS  PubMed  Google Scholar 

  44. Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM (2011) A Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Eur Urol 59:455–461

    PubMed  Google Scholar 

  45. Bryniarski P, Taborowski P, Rajwa P, Kaletka Z, Życzkowski M, Paradysz A (2017) The comparison of laparoscopic and microsurgical varicocoelectomy in infertile men with varicocoele on paternity rate 12 months after surgery: a prospective randomized controlled trial. Andrology 5:445–450

    CAS  PubMed  Google Scholar 

  46. Schauer I, Madersbacher S, Jost R, Hübner WA, Imhof M (2012) The impact of varicocelectomy on sperm parameters: a meta-analysis. J Urol 187(5):1540–1547

    PubMed  Google Scholar 

  47. Condorelli RA, Calogero AE, Mongioi L, Vicari E, Russo GI, Lanzafame F, La Vignera S (2016) Varicocele and concomitant dilation of the periprostatic venous plexus: effects on semen viscosity and sperm parameters. J Endocrinol Invest 39:543–547

    CAS  PubMed  Google Scholar 

  48. Di Bisceglie C, Bertagna A, Baldi M, Lanfranco F, Tagliabue M, Gazzera C, Gandini G, Manieri C (2007) Varicocele sclerotherapy improves serum inhibin B levels and seminal parameters. Int J Androl 30:531–536

    PubMed  Google Scholar 

  49. Fujisawa M, Dobashi M, Yamasaki T, Kanzaki M, Okada H, Arakawa S, Kamidono S (2001) Significance of serum inhibin B concentration for evaluating improvement in spermatogenesis after varicocelectomy. Hum Reprod 16:1945–1949

    CAS  PubMed  Google Scholar 

  50. Blevrakis E, Chatzidarellis E, Anyfantakis D, Sakellaris G, Raissaki M, Zoras O, Mamoulakis C, Sofras F, Chrysos E (2016) Impact of varicocele on biological markers of gonadal function. Hernia 20:435–439

    CAS  PubMed  Google Scholar 

  51. Dadfar M, Ahangarpour A, Habiby A, Khazaely D (2010) Preoperative serum level of inhibin B as a predictor of spermatogenesis improvement after varicocelectomy. Urol J 7:110–114

    PubMed  Google Scholar 

  52. Kondo Y, Ishikawa T, Yamaguchi K, Fujisawa M (2009) Predictors of improved seminal characteristics by varicocele repair. Andrologia 41:20–23

    CAS  PubMed  Google Scholar 

  53. Rodriguez Peña M, Alescio L, Russell A, Lourenco da Cunha J, Alzu G, Bardoneschi E (2009) Predictors of improved seminal parameters and fertility after varicocele repair in young adults. Andrologia 41(5):277–281

    PubMed  Google Scholar 

  54. Kimura M, Nagao K, Tai T, Kobayashi H, Nakajima K (2017) Age is a significant predictor of early and late improvement in semen parameters after microsurgical varicocele repair. Andrologia 49(3):1–6

    Google Scholar 

  55. D’Andrea S, Micillo A, Barbonetti A, Giordano AV, Carducci S, Mancini A, Decozione S, Francavilla F, Francavilla S (2017) Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men. J Endocrinol Invest 40:1145–1153

    PubMed  Google Scholar 

  56. Smith R, Kaune H, Parodi D, Madariaga M, Rios R, Morales I, Castro A (2006) Increased sperm DNA damage in patients with varicocele: relationship with seminal oxidative stress. Hum Reprod 21:986–993

    CAS  PubMed  Google Scholar 

  57. Majzoub A, Esteves SC, Gosálvez J, Agarwal A (2016) Specialized sperm function tests in varicocele and the future of andrology laboratory. Asian J Androl 182:205–212

    Google Scholar 

  58. Talebi AR, Moein MR, Tabibnejad N, Ghasemzadeh J (2008) Effect of varicocele on chromatin condensation and DNA integrity of ejaculated spermatozoa using cytochemical tests. Andrologia 40:245–251

    CAS  PubMed  Google Scholar 

  59. Blumer CG, Restelli AE, Giudice PT, Soler TB, Fraietta R, Nichi M, Bertolla RP, Cedenho AP (2012) Effect of varicocele on sperm function and semen oxidative stress. BJU Int 109:259–265

    CAS  PubMed  Google Scholar 

  60. Wang YJ, Zhang RQ, Lin YJ, Zhang RG, Zhang WL (2012) Relationship between varicocele and sperm DNA damage and the effect of varicocele repair: a meta-analysis. Reprod Biomed Online 25:307–314

    CAS  PubMed  Google Scholar 

  61. Sadek A, Almohamdy AS, Zaki A, Aref M, Ibrahim SM, Mostafa T (2011) Sperm chromatin condensation in infertile men with varicocele before and after surgical repair. Fertil Steril 95:1705–1708

    PubMed  Google Scholar 

  62. Mostafa T, Anis TH, El-Nashar A, Imam H, Othman IA (2001) Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. Int J Androl 24:261–265

    CAS  PubMed  Google Scholar 

  63. La Vignera S, Condorelli R, Vicari E, D’Agata R, Calogero AE (2012) Effects of varicocelectomy on sperm DNA fragmentation, mitochondrial function, chromatin condensation, and apoptosis. J Androl 33:389–396

    PubMed  Google Scholar 

  64. Hauser R, Yogev L, Greif M, Hirshenbein A, Botchan A, Gamzu R, Paz G, Yavetz H (1997) Sperm binding and ultrasound changes after operative repair of varicocele: correlation with fecundity. Andrologia 29:145–147

    CAS  PubMed  Google Scholar 

  65. Tavalaee M, Bahreinian M, Barekat F, Abbasi H, Nasr-Esfahani MH (2015) Effect of varicocelectomy on sperm functional characteristics and DNA methylation. Andrologia 47:904–909

    CAS  PubMed  Google Scholar 

  66. Reichart M, Eltes F, Soffer Y, Zigenreich E, Yogev L, Bartoov B (2000) Sperm ultramorphology as a pathophysiological indicator of spermatogenesis in males suffering from varicocele. Andrologia 32:139–145

    CAS  PubMed  Google Scholar 

  67. Mostafa RM, Abol-Magd R, Younis SE, Dessouki OF, Azab M, Mostafa T (2017) Assessment of seminal mast cells in infertile men with varicocele after surgical repair. Andrologia 49(3):1–5

    Google Scholar 

  68. Kohn TP, Kohn JR, Pastuszak AW (2017) Varicocelectomy before assisted reproductive technology: are outcomes improved? Fertil Steril 108:385–391

    PubMed  Google Scholar 

  69. Pathak P, Chandrashekar A, Hakky TS, Pastuszak AW (2016) Varicocele management in the era of in vitro fertilization/intracytoplasmic sperm injection. Asian J Androl 18:343–348

    CAS  PubMed  PubMed Central  Google Scholar 

  70. Samplaski MK, Lo KC, Grober ED, Zini A, Jarvi KA (2017) Varicocelectomy to “upgrade” semen quality to allow couples to use less invasive forms of assisted reproductive technology. Fertil Steril 108:609–612

    PubMed  Google Scholar 

  71. Daitch JA, Bedaiwy MA, Pasqualotto EB, Hendin BN, Hallak J, Falcone T, Thomas AJ Jr, Nelson DR, Agarwal A (2001) Varicocelectomy improves intrauterine insemination success rates in men with varicocele. J Urol 165:1510–1513

    CAS  PubMed  Google Scholar 

  72. Cayan S, Erdemir F, Ozbey I, Turek PJ, Kadioğlu A, Tellaloğlu S (2002) Can varicocelectomy significantly change the way couples use assisted reproductive technologies? J Urol 167:1749–1752

    PubMed  Google Scholar 

  73. Esteves SC, Oliveira FV, Bertolla RP (2010) Clinical outcome of intracytoplasmic sperm injection in infertile men with treated and untreated clinical varicocele. J Urol 184:1442–1446

    PubMed  Google Scholar 

  74. Kamal KM, Jarvi K, Zini A (2001) Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates. Fertil Steril 75:1013–1016

    CAS  PubMed  Google Scholar 

  75. Grober ED, Chan PT, Zini A, Goldstein M (2004) Microsurgical treatment of persistent or recurrent varicocele. Fertil Steril 82:718–722

    PubMed  Google Scholar 

  76. Evers JH, Collins J, Clarke J (2008) Surgery or embolisation for varicoceles in subfertile men. Cochrane Database Syst Rev 16:CD000479

    Google Scholar 

  77. Ficarra V, Cerruto MA, Liguori G, Mazzoni G, Minucci S, Tracia A, Gentile V (2006) Treatment of varicocele in subfertile men: the cochrane review—a contrary opinion. Eur Urol 49:258–263

    PubMed  Google Scholar 

  78. Cayan S, Shavakhabov S, Kadioglu A (2009) Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl 30:33–40

    PubMed  Google Scholar 

  79. Marmar JL, Agarwal A, Prabakaran S, Agarwal R, Short RA, Benoff S, Thomas AJ Jr (2007) Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril 88:639–648

    PubMed  Google Scholar 

  80. Kroese AC, de Lange NM, Collins J, Evers JL (2012) Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev 10:CD000479

    PubMed  Google Scholar 

  81. Mansour Ghanaie M, Asgari SA, Dadrass N, Allahkhah A, Iran-Pour E, Safarinejad MR (2012) Effects of varicocele repair on spontaneous first trimester miscarriage: a randomized clinical trial. Urol J 9:505–513

    PubMed  Google Scholar 

  82. Giagulli VA, Carbone MD (2011) Varicocele correction for infertility: which patients to treat? Int J Androl 34:236–241

    CAS  PubMed  Google Scholar 

  83. Kirby EW, Wiener LE, Rajanahally S, Crowell K, Coward RM (2016) Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis. Fertil Steril 106:1338–1343

    PubMed  Google Scholar 

  84. Esteves SC, Miyaoka R, Roque M, Agarwal A (2016) Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl 18:246–253

    PubMed  Google Scholar 

  85. Ficarra V, Crestani A, Novara G, Mirone V (2012) Varicocele repair for infertility: what is the evidence? Curr Opin Urol 22:489–494

    PubMed  Google Scholar 

  86. Smith RP, Lipshultz LI, Kovac JR (2016) Is varicocele repair necessary, given the advanced state of assisted reproductive technologies? Asian J Androl 18:349

    PubMed  PubMed Central  Google Scholar 

  87. Alsaikhan B, Alrabeeah K, Delouya G, Zini A (2016) Epidemiology of varicocele. Asian J Androl 18:179–181

    PubMed  PubMed Central  Google Scholar 

  88. World Health Organization (1992) The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril 57:1289–1293

    Google Scholar 

  89. Bogaert G, Orye C, De Win G (2013) Pubertal screening and treatment for varicocele do not improve chance of paternity as adult. J Urol 189:2298–2303

    PubMed  Google Scholar 

  90. Sack BS, Schäfer M, Kurtz MP (2017) The dilemma of adolescent varicoceles: do they really have to be repaired? Curr Urol Rep 18:38

    PubMed  PubMed Central  Google Scholar 

  91. Roque M, Esteves SC (2016) A systematic review of clinical practice guidelines and best practice statements for the diagnosis and management of varicocele in children and adolescents. Asian J Androl 18:262–268

    PubMed  Google Scholar 

  92. Goede J, Hack WW, Sijstermans K, van der Voort-Doedens LM, Van der Ploeg T, Meij-de Vries A, Delemarre-van de Waal HA (2011) Normative values for testicular volume measured by ultrasonography in a normal population from infancy to adolescence. Horm Res Paediatr 76:56–64

    CAS  PubMed  Google Scholar 

  93. Jacobson DL, Johnson EK (2017) Varicoceles in the pediatric and adolescent population: threat to future fertility? Fertil Steril 108:370–377

    PubMed  Google Scholar 

  94. Chu DI, Zderic SA, Shukla AR, Srinivasan AK, Tasian GE, Weiss DA, Long Christopher J, Canning Douglas A, Kolon Thomas F (2017) The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: a retrospective cohort study. J Pediatr Urol 13(77):e1–e5

    Google Scholar 

  95. Ku JH, Kim SW, Park K, Paick JS (2005) Benefits of microsurgical repair of adolescent varicocele: comparison of semen parameters in fertile and infertile adults with varicocele. Urology 65:554–558

    PubMed  Google Scholar 

  96. Cayan S, Sahin S, Akbay E (2017) Paternity rates and time to conception in adolescents with varicocele undergoing microsurgical varicocele repair vs observation only: a single institution experience with 408 patients. J Urol 198:195–201

    PubMed  Google Scholar 

  97. Tiseo BC, Esteves SC, Cocuzza MS (2016) Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men. Asian J Androl 18:239–245

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by University of Turin (“Ricerca locale ex-60%”).

Author information

Authors and Affiliations

  1. Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy

    M. Zavattaro, G. Motta, S. Allasia, L. Marinelli, C. Di Bisceglie, M. P. Tagliabue & F. Lanfranco

  2. Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy

    C. Ceruti, M. Sibona & L. Rolle

Authors
  1. M. Zavattaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Ceruti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Motta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Allasia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. Marinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Di Bisceglie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. P. Tagliabue
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Sibona
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Rolle
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. F. Lanfranco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Lanfranco.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zavattaro, M., Ceruti, C., Motta, G. et al. Treating varicocele in 2018: current knowledge and treatment options. J Endocrinol Invest 41, 1365–1375 (2018). https://doi.org/10.1007/s40618-018-0952-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-018-0952-7

Keywords

Search

Navigation