Varicocele correction in treatment of male subfertility: is it time to change paradigms?

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Abstract

We have analyzed the recent literature regarding varicocelectomy in men from infertile couples. The specific pathogenesis of testicular dysfunction in some men with varicocele is still unclear. Recent European and American urological guidelines suggest treatment of varicocele in infertile men with “abnormal” sperm parameters. Although, according to the 6th edition of WHO laboratory manual for the examination and processing of human semen the threshold values between normal and abnormal semen parameters are not given. It is also still unclear why approximately a third of patients do not experience improvement in fertility after varicocelectomy. According to a recent analysis, the total progressive motile sperm count (TPMSC) and sperm concentration may be important predictors of improved ejaculate quality and pregnancy after varicocelectomy. However, it should be noted that the quality of the published studies was low to moderate. All of these issues point to the need for further large-scale, multicenter, randomized clinical trials.

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About the authors

A. B. Shomarufov

Tashkent Medical Academy; Republican Specialized Scientific and Practical Medical Center of Urology

Author for correspondence.
Email: doctor.shomarufov@gmail.com

Ph.D., associate professor at the Department of Urology of Tashkent Medical Academy; consultant urologist at the Republican Specialized Scientific and Practical Medical Center of Urology

Uzbekistan, Tashkent; Tashkent

F. A. Akilov

Tashkent Medical Academy

Email: akilovmd@gmail.com

Ph.D., MD, professor, Head of the Department of Urology 

Uzbekistan, Tashkent

S. T. Mukhtarov

Republican Specialized Scientific and Practical Medical Center of Urology

Email: msht_doc@mail.ru

Ph.D., MD, Director of Republican Specialized Scientific and Practical Medical Center of Urology

Uzbekistan, Tashkent

V. A. Bozhedomov

Lomonosov Moscow State University

Email: vbojedomov@mail.ru

Ph.D., MD, Professor, Department of Urology and Andrology, Faculty of Fundamental Medicine

Russian Federation, Moscow

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