Recurrent varicocele
https://doi.org/10.21886/2308-6424-2021-9-2-132-141
Abstract
Varicocele is one of the most common problems in modern reproductive medicine. The incidence of varicocele in the structure of the general male population is 15%, 40% of which have problems with fertility. Among the causes of male infertility, varicocele ranks second after idiopathic, thus being the most common curable cause of male infertility. While researching the pathophysiological mechanisms of infertility in varicocele, the question of the reasons for the varicocele relapses, both after surgical and endovascular methods of treatment remains open, as well as the tactics of managing such patients. The review aimed to systematize knowledge about the problem of recurrent varicocele, to analyze the frequency and etiology of relapses after various methods of primary treatment, as well as to select the optimal diagnostic and treatment option for varicocele recurrence.
About the Authors
S. V. Kotov
N.I. Pirogov Russian National Research Medical University
Russian Federation
Competing Interests:
Russian Federation
Sergey V. Kotov — M.D., Dr.Sc. (M), Full Prof.; Head, Dept. of Urology and Andrology, N.I. Pirogov Russian National Research Medical University.
117997, Moscow, 1 Ostrovityanova st.
Tel.: + 7 (965) 439-48-39
Competing Interests:
The authors declare no conflicts of interest.
N. D. Korochkin
N.I. Pirogov Russian National Research Medical University
Russian Federation
Competing Interests:
Russian Federation
Nikita D. Korochkin — Resident; Dept. of Urology and Andrology, N.I. Pirogov Russian National Research Medical University.
117997, Moscow, 1 Ostrovityanova st.
Competing Interests:
The authors declare no conflicts of interest.
A. A. Klimenko
N.I. Pirogov Russian National Research Medical University
Russian Federation
Competing Interests:
Russian Federation
Aleksey A. Klimenko — Resident; Dept. of Urology and Andrology, N.I. Pirogov Russian National Research Medical University.
117997, Moscow, 1 Ostrovityanova st.
Competing Interests:
The authors declare no conflicts of interest.
References
1. Andrology. In: Nieschlag E, Behre HM and Nieschlag S (eds). Male reproductive health and dysfunction. In: Male reproductive health and dysfunction. Springer Verlag: Berlin; 2010.
2. Rotker K, Sigman M. Recurrent varicocele. Asian J Androl. 2016;18(2):229-33. DOI: 10.4103/1008-682X.171578.
3. Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology. 2000;55(5):750-4. DOI: 10.1016/s0090-4295(99)00603-2
4. Watanabe M, Nagai A, Kusumi N, Tsuboi H, Nasu Y, Kumon H. Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches. Int J Urol. 2005;12(10):892-8. DOI: 10.1111/j.1442-2042.2005.01142.x
5. Ghanem H, Anis T, El-Nashar A, Shamloul R. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Urology. 2004;64(5):1005-9. DOI: 10.1016/j.urology.2004.06.060
6. Yavetz H, Levy R, Papo J, Yogev L, Paz G, Jaffa AJ, Homonnai ZT. Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality. Int J Androl. 1992;15(4):338-44. DOI: 10.1111/ j.1365-2605.1992.tb01133.x
7. Shiraishi K, Oka S, Ito H, Matsuyama H. Comparison of the results and complications of retroperitoneal, microsurgical subinguinal, and high inguinal approaches in the treatment of varicoceles. J Androl. 2012;33(6):1387-93. DOI: 10.2164/jandrol.112.016444
8. Mehan DJ, Andrus CH, Parra RO. Laparoscopic internal spermatic vein ligation: report of a new technique. Fertil Steril. 1992;58(6):1263-6. DOI: 10.1016/s0015-0282(16)55585-x
9. Enquist E, Stein BS, Sigman M. Laparoscopic versus subinguinal varicocelectomy: a comparative study. Fertil Steril. 1994;61(6):1092-6. DOI: 10.1016/s0015-0282(16)56762-4
10. Jarow JP, Assimos DG, Pittaway DE. Effectiveness of laparoscopic varicocelectomy. Urology. 1993;42(5):544-7. DOI: 10.1016/0090-4295(93)90269-g
11. Milad MF, Zein TA, Hussein EA, Ayyat FM, Schneider MP, Sant GR. Laparoscopic varicocelectomy for infertility. An initial report from Saudi Arabia. Eur Urol. 1996;29(4):462-5. DOI: 10.1159/000473797
12. Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007;69(3):417-20. DOI: 10.1016/j.urology.2007.01.057
13. Al-Said S, Al-Naimi A, Al-Ansari A, Younis N, Shamsodini A, A-sadiq K, Shokeir AA. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008;180(1):266-70. DOI: 10.1016/j.juro.2008.03.050
14. Ding H, Tian J, Du W, Zhang L, Wang H, Wang Z. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int. 2012;110(10):1536-42. DOI: 10.1111/j.1464-410X.2012.11093.x
15. Chung SD, Wu CC, Lin VC, Ho CH, Yang SS, Tsai YC. Minilaparoscopic varicocelectomy with preservation of testicular artery and lymphatic vessels by using intracorporeal knot-tying technique: five-year experience. World J Surg. 2011;35(8):1785-90. DOI: 10.1007/s00268-011-1115-6
16. Ross LS, Ruppman N. Varicocele vein ligation in 565 patients under local anesthesia: a long-term review of technique, results and complications in light of proposed management by laparoscopy. J Urol. 1993;149(5 Pt 2):1361-3. DOI: 10.1016/s0022-5347(17)36392-9
17. Abdel-Maguid AF, Othman I. Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study. Fertil Steril. 2010;94(7):2600-3. DOI: 10.1016/j.fertnstert.2010.03.063
18. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 1992;148(6):1808-11. DOI: 10.1016/s0022-5347(17)37035-0
19. Ito H, Kotake T, Hamano M, Yanagi S. Results obtained from microsurgical therapy of varicocele. Urol Int. 1993;51(4):225-7. DOI: 10.1159/000282549
20. Jungwirth A, Gogus C, Hauser G, Gomahr A, Schmeller N, Aulitzky W, Frick J. Clinical outcome of microsurgical subinguinal varicocelectomy in infertile men. Andrologia. 2001;33(2):71-4. DOI: 10.1046/j.1439-0272.2001.00407.x
21. Kumar R, Gupta NP. Subinguinal microsurgical varicocelectomy: evaluation of the results. Urol Int. 2003;71(4):368-72. DOI: 10.1159/000074087
22. Marmar JL, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol. 1994;152(4):1127-32. DOI: 10.1016/s0022-5347(17)32521-1
23. Orhan I, Onur R, Semercioz A, Firdolas F, Ardicoglu A, Koksal IT. Comparison of two different microsurgical methods in the treatment of varicocele. Arch Androl. 2005;51(3):213-20. DOI: 10.1080/01485010590919648
24. Kim SO, Jung H, Park K. Outcomes of microsurgical subinguinal varicocelectomy for painful varicoceles. J Androl. 2012;33(5):872-5. DOI: 10.2164/jandrol.111.014993
25. Nabi G, Asterlings S, Greene DR, Marsh RL. Percutaneous embolization of varicoceles: outcomes and correlation of semen improvement with pregnancy. Urology. 2004;63(2):359-63. DOI: 10.1016/j.urology.2003.09.026
26. Gandini R, Konda D, Reale CA, Pampana E, Maresca L, Spinelli A, Stefanini M, Simonetti G. Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate--outcome in 244 patients. Radiology. 2008;246(2):612-8. DOI: 10.1148/radiol.2462061295
27. Li L, Zeng XQ, Li YH. Safety and effectiveness of transcatheter foam sclerotherapy for testicular varicocele with a fluoroscopic tracing technique. J Vasc Interv Radiol. 2010;21(6):824-8. DOI: 10.1016/j.jvir.2010.02.026
28. Galfano A, Novara G, Iafrate M, Fracalanza S, Novella G, Cavalleri S, Artibani W, Ficarra V. Surgical outcomes after modified antegrade scrotal sclerotherapy: a prospective analysis of 700 consecutive patients with idiopathic varicocele. J Urol. 2008;179(5):1933-7. DOI: 10.1016/j.juro.2008.01.042
29. Wishahi MM. Anatomy of the spermatic venous plexus (pampiniform plexus) in men with and without varicocele: intraoperative venographic study. J Urol. 1992;147(5):1285-9. DOI: 10.1016/s0022-5347(17)37544-4
30. Lechter A, Lopez G, Martinez C, Camacho J. Anatomy of the gonadal veins: a reappraisal. Surgery. 1991;109(6):735-9. PMID: 2042092
31. Favorito LA, Costa WS, Sampaio FJ. Applied anatomic study of testicular veins in adult cadavers and in human fetuses. Int Braz J Urol. 2007;33(2):176-80. DOI: 10.1590/s1677-55382007000200007
32. Valji K. Endocrine, exocrine and reproductive system. In: Valji K, ed. The practice of interventional radiology, with online cases and video. 1st ed. Philadelphia: Elsevier Saunders;.2011.
33. Bahren W, Lenz M, Porst H, Wierschin W. Nebenwirkungen, Komplikationen und Kontraindikationen der perkutanen Sklerotherapie der V. spermatica interna zur Behandlung der idiopathischen Varikozele [Side effects, complications and contraindications for percutaneous sclerotherapy of the internal spermatic vein in the treatment of idiopathic varicocele]. Rofo. 1983;138(2):172-9. (In German). DOI: 10.1055/s-2008-1055705
34. Murray RR Jr, Mitchell SE, Kadir S, Kaufman SL, Chang R, Kinnison ML, Smyth JW, White RI Jr. Comparison of recurrent varicocele anatomy following surgery and percutaneous balloon occlusion. J Urol. 1986;135(2):286-9. DOI: 10.1016/s0022-5347(17)45615-1
35. Sze DY, Kao JS, Frisoli JK, McCallum SW, Kennedy WA 2nd, Razavi MK. Persistent and recurrent postsurgical varicoceles: venographic anatomy and treatment with N-butyl cyanoacrylate embolization. J Vasc Interv Radiol. 2008;19(4):539-45. DOI: 10.1016/j.jvir.2007.11.009
36. Goren MR, Erbay G, Ozer C, Kayra MV, Hasirci E. Can We Predict the Outcome of Varicocelectomy Based on the Duration of Venous Reflux? Urology. 2016;88:81-6. DOI: 10.1016/j.urology.2015.11.032
37. Gorur S, Candan Y, Helli A, Akcin S, Cekirge SD, Kaya YS, Cekic C, Kiper AN. Low body mass index might be a predisposing factor for varicocele recurrence: a prospective study. Andrologia. 2015;47(4):448-54. DOI: 10.1111/and.12287
38. Li S, Liu Q, Wang J, Pang X, Zhang Y, Cheng Y, Fu Y, Guo J, Tang Y, Zeng H, Yang Y, Zhu Z. Association Between Left Renal Vein Entrapment and Varicocele Recurrence: A Cohort Study in 3042 Patients. Sci Rep. 2018;8:10534. DOI: 10.1038/s41598-018-28887-9
39. Coolsaet BL. The varicocele syndrome: venography determining the optimal level for surgical management. J Urol. 1980;124(6):833-9. DOI: 10.1016/s0022-5347(17)55688-8
40. Franco G, Iori F, de Dominicis C, Dal Forno S, Mander A, Laurenti C. Challenging the role of cremasteric reflux in the pathogenesis of varicocele using a new venographic approach. J Urol. 1999;161(1):117-21. PMID: 10037382
41. Franco G, Leonardo C. Is selective internal spermatic venography necessary in detecting recurrent varicocele after surgical repair? Eur Urol. 2002;42(2):192-3. DOI: 10.1016/s0302-2838(02)00262-2
42. Jargiello T, Drelich-Zbroja A, Falkowski A, Sojka M, Pyra K, Szczerbo-Trojanowska M. Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure. Acta Radiol. 2015;56(1):63-9. DOI: 10.1177/0284185113519624
43. Zhukov O.B., Ukolov V.A., Babushkina E.V., Evdokimov V.V. Recurrent varicocele and May-Thurner syndrome. Vestnik Urologii. 2018;6(3):17-25. (In Russ.). DOI: 10.21886/23086424-2018-6-3-17-25
44. Kapto A.A. May-Thurner syndrome and varicose veins of the pelvic organs in men. Andrology and Genital Surgery. 2018;19(4):28-38. (In Russ.). DOI: 10.17650/2070-97812018-19-4-28-38
45. Studennikova V.V., Severgina L.O., Carichenko D.G., Ismailov M.T., Korovin I.A., Rapoport L.M., Zaharov A.I., Petruhina Ju.V. An actual view on the varicocele pathogenesis and the problem of the reccurence development. Urologiia. 2018;1:150-154. (In Russ.). DOI: 10.18565/urology.2018.1.150-154
46. Kravtsov Yu.A., Makarov V.I., Sichinava Z.A., Polushin O.G., Yavorskaya M.V. The role of the undifferentiated connective tissue dysplasia syndrome in the recurrence of varicocele. Sibirskii meditsinskii zhurnal. 2011;26(3):92-96. (In Russ.). eLIBRARY ID: 16903684
47. Cvitanic OA, Cronan JJ, Sigman M, Landau ST. Varicoceles: postoperative prevalence--a prospective study with color Doppler US. Radiology. 1993;187(3):711-4. DOI: 10.1148/radiology.187.3.8497618
48. Yan TZ, Wu XQ, Wang ZW. Treatment effect of TUSPLV on recurrent varicocele. Exp Ther Med. 2017;13(1):45-48. DOI: 10.3892/etm.2016.3931
49. Grober ED, Chan PT, Zini A, Goldstein M. Microsurgical treatment of persistent or recurrent varicocele. Fertil Steril. 2004;82(3):718-22. DOI: 10.1016/j.fertnstert.2004.03.028
50. Madjar S, Moskovitz B, Issaq E, Weinberger M, Nativ O. Low inguinal approach for correction of recurrent varicocele. Int Urol Nephrol. 1998;30(1):69-73. DOI: 10.1007/BF02550281
51. Mazzoni G, Minucci S, Gentile V. Recurrent varicocele: role of antegrade sclerotherapy as first choice treatment. Eur Urol. 2002;41(6):614-8; discussion 618. DOI: 10.1016/s0302-2838(02)00128-8
52. Kim J, Shin JH, Yoon HK, Ko GY, Gwon DI, Kim EY, Sung KB. Persistent or recurrent varicocoele after failed varicocoelectomy: outcome in patients treated using percutaneous transcatheter embolization. Clin Radiol. 2012;67(4):359-65. DOI: 10.1016/j.crad.2011.10.007
53. fayan S, Orhan i, Akbay E, Kadioglu A. Systematic review of treatment methods for recurrent varicoceles to compare post-treatment sperm parameters, pregnancy and complication rates. Andrologia. 2019;51(11):e13419. DOI: 10.1111/and.13419
54. Ozkaptan O, Balaban M, Sevinc C, fubuk A, Sahan A, Akca O. Impact of intra-operative doppler ultrasound assistance during microsurgical varicocelectomy on operative outcome and sperm parameters. Andrologia. 2020;52(7):e13641. DOI: 10.1111/and.13641
55. Chen SS. Predictive factors of successful redo varicocelectomy in infertile patients with recurrent varicocele. Andrologia. 2014;46(7):738-43. DOI: 10.1111/and.12142
56. fayan S, Akbay E. Fate of Recurrent or Persistent Varicocele in the Era of Assisted Reproduction Technology: Microsurgical Subinguinal Redo Varicocelectomy Versus Observation. Urology. 2018;117:64-69. DOI: 10.1016/j.urology.2018.03.046
Review
For citations:
Kotov S.V., Korochkin N.D., Klimenko A.A. Recurrent varicocele. Urology Herald. 2021;9(2):132-141. (In Russ.) https://doi.org/10.21886/2308-6424-2021-9-2-132-141
Views:
36940
Email this article 
