Subclinical varicocele: criteria for diagnosis, a role in the development of male infertility, a modern approach to treatment


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Abstract

Subclinical varicocele is characterized by the nonpalpable veins of the spermatic cord and the absence of visible scrotal changes at rest and during Valsalva maneuver. Pathologically dilated veins are identified using Doppler ultrasound. Correction of clinical varicocele in infertile males has been proven to improve spermogram parameters and to increase the chance of fertilization in most patients. However, surgical treatment for subclinical varicocele is controversial and remains a matter of debate. Thirty-four articles have been analyzed using the MEDLINE/ PubMed database regarding the treatment of subclinical varicocele. The authors have compared information on the effects of subclinical varicocele on male fertility. They have evaluated the efficiency and feasibility of performing microsurgical correction of subclinical varicocele in infertile males. Conclusion. Surgical treatment as microsurgical subinguinal ligation of the spermatic cord veins is indicated for the treatment of infertile patients with subclinical varicocele. In the cases that left clinical varicocele is concurrent with contralateral subclinical varicocele, surgical treatment should be performed on both sides.

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About the authors

Nika D. Akhvlediani

A.I Evdokimov Moscow State University of Medicine and Dentisty

Email: nikandro@mail.ru
Doctor of Medical Sciences, Professor of the Department of Urology

Artem S. Chernushenko

A.I Evdokimov Moscow State University of Medicine and Dentisty

Email: artemchernushenko@gmail.com
urologist, University Clinic “Kuskovo”

Igor A. Reva

A.I Evdokimov Moscow State University of Medicine and Dentisty

Email: reva-igor@rambler.ru
Candidate of Medical Sciences, acting Head of the Department of Urology, University Hospital “Kuskovo”

Dmitry Yu. Pushkar

A.I Evdokimov Moscow State University of Medicine and Dentisty

Email: pushkardm@mail.ru
Academician of the Russian Academy of Sciences, Professor, Head of the Department of Urology

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