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REVIEW ARTICLE
Year : 2006  |  Volume : 22  |  Issue : 2  |  Page : 98-104

Varicocele and the urologist


Dept. of Urology, All India Institute of Medical Sciences, New Delhi - 110 029, India

Correspondence Address:
Rajeev Kumar
Dept. of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.26561

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Varicoceles are variably considered the commonest 'correctable' cause of male infertility or the commonest 'over-reported' cause of infertility, depending on the individual viewpoint. This dichotomy has resulted from a lack of clear understanding of the effect of varicoceles on spermatogenesis and an absence of well-designed trials to evaluate the outcomes. This is coupled with surgery in unclear indications and sometimes by surgeons with limited surgical skills who assume that the surgery can cause no harm. A recent debate on 'Are we overdoing varicocelectomies' that was initiated by the Urological Society of India at its annual meeting in 2006 prompted us to review the recent developments in the fields of pathogenesis and surgical technique and the issue of 'overdoing' varicocelectomies. A review of recent literature on the subject was performed. There is an increasing body of evidence pointing towards the role of reactive oxygen species (ROS) and oxidative stress in the pathogenesis of varicocele related subfertility. This has been found in studies evaluating both direct and indirect markers of oxidative stress. Apoptosis and DNA fragmentation may be the end effectors of ROS induced damage. Other proposed etiologic factors are tissue hypoxia and hormonal imbalances. Among the various therapeutic options for varicoceles, microsurgical ligation has the best results with minimal complications. Loupe magnification may be an acceptable alternative in case of non availability of expertise with microsurgery or the microscope itself. The anatomical reasons for this and the studies on which this conclusion is based are reviewed. Finally, we discuss the problem of too many varicocele surgeries and its possible demerits. We also review the current guidelines and the need for proper case selection before surgery.


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