[Varicocele and male infertility].
Varicocèle et infertilité masculine.
Aide médicale à la procréation
Chirurgie
Embolisation
Embolization
Grossesse
Medically assisted reproduction
Pregnancy
Surgery
Varicocele
Varicocèle
Journal
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie
ISSN: 1166-7087
Titre abrégé: Prog Urol
Pays: France
ID NLM: 9307844
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
22
08
2023
accepted:
04
09
2023
medline:
29
11
2023
pubmed:
28
11
2023
entrez:
28
11
2023
Statut:
ppublish
Résumé
Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d'urologie (AFU) Comité d'andrologie et de médecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional information. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances. Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023. Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery. Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.
Sections du résumé
BACKGROUND
BACKGROUND
Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d'urologie (AFU) Comité d'andrologie et de médecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional information. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances.
METHODS
METHODS
Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023.
RESULTS
RESULTS
Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery.
CONCLUSION
CONCLUSIONS
Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.
Identifiants
pubmed: 38012908
pii: S1166-7087(23)00208-7
doi: 10.1016/j.purol.2023.09.003
pii:
doi:
Types de publication
Review
English Abstract
Journal Article
Langues
fre
Sous-ensembles de citation
IM
Pagination
624-635Informations de copyright
Copyright © 2023. Published by Elsevier Masson SAS.