Is the treatment of varicocele surgical?

Varicocele is one of the most common abnormalities in men who cannot conceive their spouses. Varicocele has been one of the most accused causes of infertility for years. It is useful to examine the relationship between varicocele and infertility from different perspectives. The enlargement of the vascular system, which is called the pampiniform plexus and carries dirty blood from the testicles, is called varicocele. Varicocele can be seen, palpable or detected by Doppler ultrasound examination. Varicoceles detected by Doppler ultrasound are called subclinical varicoceles. In men with varicocele, the most prominent complaint, apart from infertility, is chronic inguinal pain and a feeling of pressure. Today, it is accepted that only clinical varicocele, that is, visible or palpable varicocele, is important.

20% of men who have had their spouses pregnant before have varicocele. In infertile couples where the woman is normal, the incidence of varicocele is around 35%-40%. Clinical varicocele is seen in 25% of young men enlisted in the USA. In the long-term follow-up of these men, there was no difference in the rate of conceiving of their spouses between those with and without varicocele.

There is no universally accepted theory about how varicocele causes infertility. Although it has been reported that sperm morphology and movement disorder, called stress pattern, is observed in the semen of men with varicocele, the fact that similar disorders have also been observed in men without varicocele casts a shadow over the importance of this finding. Unfortunately, not all studies showed a difference in sperm count, motility and structural features in men with varicocele compared to men without varicocele.

The treatment of varicocele today is surgery. With an operation called spermatic vein ligation with microsurgery, varicose enlarged veins are ligated. This operation can be performed endoscopically or radiological embolization techniques can be used. Since there is no comparative study of the techniques, there is no definite consensus on which one is superior. The generally accepted view among urologists is that there is no benefit in repairing subclinical varicoceles. There is also a consensus on the treatment of clinical, palpable or visible varicoceles, especially those associated with chronic inguinal pain or pressure, and varicoceles seen in adolescence. Although it is widely performed by urologists, a more skeptical issue by andrologists and gynecologists is whether varicocele repair is beneficial in infertile men with impaired semen parameters. When the well-designed (randomized) studies were evaluated collectively, it was observed that there was no change in the chances of conceiving the wives of men with and without varicocele repair. It was concluded that varicocele repair has no place, especially in cases of azoospermia or severe sperm count (3 million/ml and below). In cases where the sperm count is over 5 million, the woman is young, and the infertility period is short, varicocele repair can be considered.

In post-operative recurrent varicoceles, a second surgery has no place unless the patient has complaints.

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