Varicocele: Current concepts in pathophysiology, diagnosis, and treatment

Urologic Clinics of North America

Volumn 29, Issue 4, 2002, Pages 921-937

  Fretz, Peter C ^a   Sandlow, Jay I ^a  

^a UNIVERSITY OF IOWA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIOXIDANT; CLOMIFENE CITRATE;

ADULT; COST EFFECTIVENESS ANALYSIS; DRUG EFFECT; HUMAN; INCIDENCE; LAPAROSCOPIC SURGERY; MAJOR CLINICAL STUDY; MALE; MALE INFERTILITY; OUTCOMES RESEARCH; PATHOPHYSIOLOGY; PHLEBOGRAPHY; PRIORITY JOURNAL; REVIEW; SEMEN ABNORMALITY; SEMINIFEROUS TUBULE; SPERMATOGENESIS; STEROIDOGENESIS; SURGICAL APPROACH; SURGICAL TECHNIQUE; TESTIS FUNCTION; VARICOCELE;

HUMANS; MALE; VARICOCELE;

EID: 0036867863     PISSN: 00940143     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0094-0143(02)00075-7     Document Type: Review

References (167)

1. Schmidt L, Munster K, Helm P. Infertility and the seeking of infertility treatment in a representative population. Br J Obstet Gynecol 1995;102(12):978-84.
2. Schlesinger MH, Wilets IF, Nagler HM. Treatment outcome after varicocelectomy: A critical analysis. Urol Clin North Am 1994;21(3):517-29.
3. World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril 1992;57(6):1289-93.
4. Sylora JA, Pryor JL. Varicocele. Curr Ther Endocrinol Metab 1994;5:309-14.
5. Pinto KJ, Kroovand RL, Jarow JP. Varicocele related testicular atrophy and its predictive effect upon fertility. J Urol 1994;152(2 pt 2):788-90.
6. Green KF, Turner TT, Howards SS. Varicocele: Reversal of the testicular blood flow and temperature effects by varicocele repair. J Urol 1984;131(6):1208-11.
7. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril 1993;59(3):613-6.
8. Saypol DC, Howards SS, Turner TT, et al. Influence of surgically induced varicocele on testicular blood flow, temperature, and histology in adult rats and dogs. J Clin Invest 1981;68(1):39-45.
9. Witt MA, Lipshultz LI. Varicocele: A progressive or static lesion? Urology 1993;42(5):541-3.
10. Chehval MJ, Purcell MH. Deterioration of semen parameters over time in men with untreated varicocele: Evidence of progressive testicular damage. Fertil Steril 1992;57(1):174-7.
11. Walmsley K, Coleman JA, Goldstein M. The inheritance of varicocele. J Urol 2001;165(5 Suppl):334.
12. Mellinger BC. Varicocelectomy. Tech Urol 1995;1(4):188-96.
13. Parrott TS, Hewartt L. Ligation of the testicular artery and vein in adolescent varicocele. J Urol 1994;152(2 pt 2):791-3.
14. Yamamoto M, Tsuji Y, Ohmura M, et al. Comparison of artery-ligating and artery-preserving varicocelectomy: Effect on postoperative spermatogenesis. Andrologia 1995;27(1):37-40.
15. Beck EM, Schlegel PN, Goldstein M. Intraoperative varicocele anatomy: A macroscopic and microscopic study. J Urol 1992;148(4):1190-4.
16. Shafik A, Moftah A, Olfat S, et al. Testicular veins: Anatomy and role in varicocelogenesis and other pathologic conditions. Urology 1990;35(2):175-82.
17. Coolsaet BL. The varicocele syndrome: Venography determining the optimal level for surgical management. J Urol 1980;124(6):833-9.
18. Dennison AR, Tibbs DJ. Varicocele and varicose veins compared: A basis for logical surgery. Urology 1986;28(3):211-7.
19. Turek PJ, Lipshultz LI. The Varicocele Controversies. I. Etiology and Pathophysiology. AUA Update Series, vol. 14, lesson 13. Baltimore: American Urological Association; 1995. p. 106-11.
20. Wishahi MM. Anatomy of the venous drainage of the human testis: Testicular vein cast, microdissection and radiographic demonstration. A new anatomical concept. Eur Urol 1991;20(2):154-60.
21. Wishahi MM. Detailed anatomy of the internal spermatic vein and the ovarian vein. Human cadaver study and operative spermatic venography: Clinical aspects. J Urol 1991;145(4):780-4.
22. Wang YX, Lei C, Dong SG, et al. Study of bilateral histology and meiotic analysis in men undergoing varicocele ligation. Fertil Steril 1991;55(1):152-5.
23. Paduch DA, Skoog SJ. Current management of adolescent varicocele. Rev Urol 2001;3(3):120-33.
24. Agarwal S. Vascular morphology in testes of infertile males with varicocele. Indian J Med Res 1991;94:228-31.
25. Tanji N, Fujiwara T, Kaji H, et al. Histologic evaluation of spermatic veins in patients with varicocele. Int J Urol 1999;6(7):355-60.
26. Lund L, Hahn-Pedersen J, Hljhus J, et al. Varicocele testis evaluated by CT scanning. Scand J Urol Nephrol 1997;31(2):179-82.
27. Lund L, Ernst E, Sorensen HT, et al. Biomechanical properties of normal and varicose internal spermatic veins. Scand J Urol Nephrol 1998;32(1):47-50.
28. Psaila JV, Melhuish J. Viscoelastic properties and collagen content of the long saphenous vein in normal and varicose veins. Br J Surg 1989;76(1):37-40.
29. Santoro G, Romeo C, Impellizzeri P, et al. Ultrastructural and immunohistochemical study of basal lamina of the testis in adolescent varicocele. Fertil Steril 2000;73(4):699-705.
30. Cameron DF, Snydle FE. The blood-testis barrier in men with varicocele: A lanthanum tracer study. Fertil Steril 1980;34(3):255-8.
31. Turner TT, Jones CE, Roddy MS. Experimental varicocele does not affect the blood-testis barrier, epididymal electrolyte concentrations, or testicular blood gas concentrations. Biol Reprod 1987;36(4):926-32.
32. Sigman M, Howards SS. Male infertility. In: Walsh PC, Retik AB, Vaughn ED, Wein AJ, editors. Campbell's Urology. 7th Edition. Philadelphia: WB Saunders; 1997. p. 1287-330.
33. Turner TT. Varicocele: Still an enigma. J Urol 1983;129(4):695-9.
34. Braedel HU, Steffens J, Ziegler M, et al. A possible ontogenic etiology for idiopathic left varicocele. J Urol 1994;151(1):62-6.
35. Grillo-Lopez AJ. Primary right varicocele. J Urol 1971;105(4):540-1.
36. Dubin L, Amelar RD. Surgical therapy for male infertility. J Reprod Med 1977;18(4):211-7.
37. Hargreave TB. Debate on the pros and cons of varicocele treatment - In favour of varicocele treatment. Hum Reprod 1995;:10(Suppl 1):151-7.
38. Comhaire F, Zalata A, Schoonjans F. Varicocele: Indications for treatment. Ant J Androl 1995;18(Suppl 2):67-71.
39. Etriby AA, Ibrahim AA, Mahmoud KZ, et al. Subfertility and varicocele. I. Venogram demonstration of anastomosis sites in subfertile men. Fertil Steril 1975;26(10):1013-7.
40. Goldstein M, Eid JF. Elevation of intratesticular and scrotal skin surface temperature in men with varicocele. J Urol 1989;142(3):743-5.
41. Hurt GS, Howards SS, Turner TT. Repair of experimental varicoceles in the rat: Long-term effects on testicular blood flow and temperature and cauda epididymal sperm concentration and motility. J Androl 1986;7(5):271-6.
42. Zorgniotti AW, Macleod J. Studies in temperature, human semen quality, and varicocele. Fertil Steril 1973;24(11):854-63.
43. Lund L, Nielsen KT. Varicocele testis and testicular temperature. Br J Urol 1996;78(1):113-5.
44. Wright EJ, Young GP, Goldstein M. Reduction in testicular temperature after varicocelectomy in infertile men. Urology 1997;50(2):257-9.
45. Dahl EV, Herrick JF. A vascular mechanism for maintaining testicular temperature by countercurrent exchange. Surg Gynecol Obstet 1959;108:697-705.
46. Mieusset R, Bujan L. Testicular heating and its possible contributions to male infertility: A review. Int J Androl 1995;18(4):169-84.
47. Fujisawa M, Yoshida S, Matsumoto O, et al. Deoxyribonucleic acid polymerase activity in the testes of infertile men with varicocele. Fertil Steril 1988;50(5):795-800.
48. Simsek F, Turkeri L, Cevik I, et al. Role of apoptosis in testicular tissue damage caused by varicocele. Arch Esp Urol 1998;51(9):947-50.
49. Yin Y, Hawkins KL, DeWolf WC, et al. Heat stress causes testicular germ cell apoptosis in adult mice. J Androl 1997;18(2):159-65.
50. Lue Y, Hikim AP, Wang C, et al. Testicular heat exposure enhances the suppression of spermatogenesis by testosterone in rats: The "two-hit" approach to male contraceptive development. Endocrinology 2000;141(4):1414-24.
51. MacLeod J. Seminal cytology in the presence of varicocele. Fertil Steril 1965;16:735-57.
52. Cohen MS, Plainse L, Brown JS. The role of internal spermatic vein plasma catecholamine determinations in subfertile men with varicoceles. Fertil Steril 1975;26(12):1243-9.
53. Ito H, Fuse H, Minagawa H, et al. Internal spermatic vein prostaglandins in varicocele patients. Fertil Steril 1982;37(2):218-22.
54. Lindholmer C, Thulin L, Eliasson R. Concentrations of cortisol and renin in the internal spermatic vein of men with varicocele. Andrologia 1973;5(1):21-2.
55. Sofikitis N, Miyagawa I. Left adrenalectomy in varicelized rats does not inhibit the development of varicele-related physiologic alterations. Int J Fertil Menopausal Stud 1993;38(4):250-5.
56. Steeno O, Koumans J, De Moor P. Adrenal cortical hormones in the spermatic vein of 95 patients with left varicocele. Andrologia 1976;8(2):101-4.
57. York JP, Klump R, Smith JJ, et al. The role of the adrenal in the rat varicocele model. In Vivo 1990;4(2):145-7.
58. Turner TT, Lopez TJ. Effects of experimental varicocele require neither adrenal contribution nor venous reflux. J Urol 1989;142(5):1372-5.
59. Ozbek E, Yurekli M, Soylu A, et al. The role of adrenomedullin in varicocele and impotence. BJU Int 2000;86(6):694-8.
60. Shafik A, Bedeir GA. Venous tension patterns in cord veins. I. In normal and varicocele individuals. J Urol 1980;123(3):383-5.
61. Shafik A. Venous tension patterns in cord veins. II. After varicocele correction. J Urol 1983;129(4):749-51.
62. Donohue RE, Brown JS. Blood gases and pH determinations in the internal spermatic veins of subfertile men with varicocele. Fertil Steril 1969;20(2):365-9.
63. Netto Jr NR, Lemos GC, De Goes GM. Varicocele: Relation between anoxia and hypospermatogenesis. Int J Fertil 1977;22(3):174-8.
64. Di Luigi L, Gentile V, Pigozzi F, et al. Physical activity as a possible aggravating factor for athletes with varicocele: Impact on the semen profile. Hum Reprod 2001;16(6):1180-4.
65. Tanji N, Tanji K, Hiruma S, et al. Histochemical study of human cremaster in varicocele patients. Arch Androl 2000;45(3):197-202.
66. Uygur MC, Arik AI, Erol D, et al. Quantitative evaluation of biopty gun testis needle biopsy: Correlation between biopsy score of varicocele-bearing testis and sperm count. J Reprod Med 1999;44(5):445-9.
67. Romeo C, Santoro G, Impellizzeri P, et al. Myofibroblasts in adolescent varicocele: An ultrastructural and immunohistochemical study. Urol Res 2000;28(1):24-8.
68. Griveau JF, LeLannon D. Reactive oxygen species and human spermatozoa: Physiology and pathology. Int J Androl 1997;20(2):61-9.
69. Sharma RK, Agarwal A. Role of reactive oxygen species in male infertility. Urology 1996;48(6):835-50.
70. Sikka SC. Oxidative stress and role of antioxidants in normal and abnormal sperm function. Front Biosci 1996;1:e78-86.
71. Hendin BN, Kolettis PN, Sharma RK, et al. Varicocele is associated with elevated spermatozoal reactive oxygen species production and diminished seminal plasma antioxidant capacity. J Urol 1999;161(6):1831-4.
72. Mazzilli F, Rossi T, Marchesini M, et al. Superoxide anion in human semen related to seminal parameters and clinical aspects. Fertil Steril 1994;62(4):862-8.
73. Pasqualotto FF, Sharma RK, Kobayashi H, et al. Oxidative stress in normospermic men undergoing infertility evaluation. J Androl 2001;22(2):316-22.
74. Mostafa T, Amis TH, El-Nashar A, et al. Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. Int J Androl 2001;24(5):261-5.
75. Peng BC, Tomashefsky P, Nagler HM. The cofactor effect: Varicocele and infertility. Fertil Steril 1990;54(1):143-8.
76. Klaiber EL, Broverman DM, Vogel W. Increased incidence of testicular varicoceles in cigarette smokers. Fertil Steril 1980;34(1):64-5.
77. Chia SE, Xu B, Ong CN, et al. Effect of cadmium and cigarette smoking on human semen quality. Int J Fertil Menopausal Stud 1994;39(5):292-8.
78. Klaiber EL, Broverman DM, Pokoly TB, et al. Interrelationships of cigarette smoking, testicular varicoceles, and seminal fluid indexes. Fertil Steril 1987;47(3):481-6.
79. Gilbert BR, Witkin SS, Goldstein M. Correlation of sperm-bound immunoglobulins with impaired semen analysis in infertile men with varicocele. Fertil Steril 1989;52(3):469-73.
80. Knudson G, Ross L, Stuhldreher D, et al. Prevalence of sperm bound antibodies in infertile men with varicocele: The effect of varicocele ligation on antibody levels and semen response. J Urol 1994;151(5):1260-2.
81. Baccetti B, Collodel G, Piomboni P. Apoptosis in human ejaculated sperm cells (notulae seminologicae). J Submicrosc Cytol Pathol 1996;28(4):587-96.
82. Hsueh AJ, Eisenhauer K, Chun SY, et al. Gonadal cell apoptosis. Recent Prog Horm Res 1996;51:433-55.
83. Yan H, Carter CE, Xu C, et al. Cadmium-induced apoptosis in the urogenital organs of the male rat and its suppression by chelation. J Toxicol Environ Health 1997;52(2):149-68.
84. Benoff S, Gilbert BR. Varicocele and male infertility: Part 1. Hum Reprod Update 2001;7(1):47-54.
85. Benoff S, Hurley IR, Barcia M, et al. A potential role for cadmium in the etiology of varicocele-associated infertility. Fertil Steril 1997;67(2):336-47.
86. Hikim AP, Wang C, Leung A, et al. Involvement of apoptosis in the induction of germ cell degeneration in adult rats after gonadotropin-releasing hormone antagonist treatment. Endocrinology 1995;136(6):2770-5.
87. Fujisawa M, Yoshida S, Matsumoto O, et al. Decrease of topoisomerase 1 activity in the testes of infertile men with varicocele. Arch Androl 1988;21(1):45-50.
88. Fujisawa M, Matsumoto O, Kamidono S, et al. Changes of enzymes involved in DNA synthesis in the testes of cryptorchid rats. J Reprod Fertil 1988;84(1):123-30.
89. Tulloch WS. Varicocele in subfertility: Results of treatment. BMJ 1955;2:356.
90. Lipshultz LI, Corriere Jr JN. Progressive testicular atrophy in the varicocele patient. J Urol 1977;117(2):175-6.
91. Setchell BP. The Parkes Lecture: Heat and the testis. J Reprod Fertil 1998;114(2):179-94.
92. Ayodeji O, Baker HW. Is there a specific abnormality of sperm morphology in men with varicoceles? Fertil Steril 1986;45(6):839-42.
93. Naftulin BN, Samuels SJ, Hellstrom WJ, Lewis EL, Overstreet JW. Semen quality in varicocele patients is characterized by tapered sperm cells. Fertil Steril 1991;56(1):149-51.
94. Rodriguez-Rigau LJ, Smith KD, Steinberger E. Varicocele and the morphology of spermatozoa. Fertil Steril 1981;35(1):54-7.
95. Schatte EC, Hirshberg SJ, Fallick ML, et al. Varicocelectomy improves sperm strict morphology and motility. J Urol 1998;160(4):1338-40.
96. Seftel AD, Rutchik SD, Chen H, et al. Effects of subinguinal varicocele ligation on sperm concentration, motility and Kruger morphology. J Urol 1997;158(5):1800-3.
97. Vazquez-Levin MH, Freidmann P, Goldberg SI, et al. Response of routine semen analysis and critical assessment of sperm morphology by Kruger classification to therapeutic varicocelectomy. J Urol 1997;158(5):1804-7.
98. Vigil P, Wohler C, Bustos-Obregon E, et al. Assessment of sperm function in fertile and infertile men. Andrologia 1994;26(2):55-60.
99. Ando S, Giacchetto C, Beraldi E, et al. Testosterone and dihydrotestosterone seminal plasma levels in varicocele patients. Andrologia 1983;15(4):374-9.
100. Younes AK. Low plasma testosterone in varicocele patients with impotence and male infertility. Arch Androl 2000;45(3):187-95.
101. Hudson RW, Hayes KA, Crawford VA, et al. Seminal plasma testosterone and dihydrotestosterone levels in men with varicoceles. Int J Androl 1983;6(2):135-42.
102. Swerdloff RS, Walsh PC. Pituitary and gonadal hormones in patients with varicocele. Fertil Steril 1975;26(10):1006-12.
103. Hudson RW. The endocrinology of varicoceles. Fertil Steril 1988;49(2):199-208.
104. Sirvent JJ, Bernat R, Navarro MA, et al. Leydig cell in idiopathic varicocele. Eur Urol 1990;17(3):257-61.
105. Cayan S, Kadioglu A, Orhan I, et al. The effect of microsurgical varicocelectomy on serum follicle stimulating hormone, testosterone and free testosterone levels in infertile men with varicocele. BJU Int 1999;84(9):1046-9.
106. Su LM, Goldstein M, Schlegel PN. The effect of varicocelectomy on serum testosterone levels in infertile men with varicoceles. J Urol 1995;154(5):1752-5.
107. Jensen TK, Andersson AM, Hjollund NH, et al. Inhibin B as a serum marker of spermatogenesis: Correlation to differences in sperm concentration and follicle-stimulating hormone levels. A study of 349 Danish men. J Clin Endocrinol Metab 1997;82(12):4059-63.
108. Pierik FH, Van Ginneken AM, Dohle GR, et al. The advantages of standardized evaluation of male infertility. Int J Androl 2000;23(6):340-6.
109. Li H, Dubocq F, Jiang Y, et al. Effect of surgically induced varicocele on testicular blood flow and Sertoli cell function. Urology 1999;53(6):1258-62.
110. Kosar A, Sarica K, Ozdiler E. Effect of varicocelectomy on seminal plasma transferrin values: A comparative clinical trial. Andrologia 2000;32(1):19-22.
111. Hargreave TB, Liakatas J. Physical examination for varicocele. Br J Urol 1991;67(3):328.
112. Petros JA, Andriole GL, Middleton WD, et al. Correlation of testicular color Doppler ultrasonography, physical examination and venography in the detection of left varicoceles in men with infertility. J Urol 1991;145(4):785-8.
113. Pierik FH, Dohle GR, van Muiswinkel JM, et al. Is routine scrotal ultrasound advantageous in infertile men? J Urol 1999;162(5):1618-20.
114. Rivkees SA, Hall DA, Boepple PA, et al. Accuracy and reproducibility of clinical measures of testicular volume. J Pediatr 1987;110(6):914-7.
115. Daitch JA, Bedaiwy MA, Pasqualotto EB, et al. Varicocelectomy improves intrauterine insemination success rates in men with varicocele. J Urol 2001;165(5):1510-3.
116. Lewis RW, Harrison RM. Contact scrotal thermography: Application to problems of infertility. J Urol 1979;122(1):40-2.
117. Basile-Fasolo C, Izzo PL, Canale D, et al. Doppler sonography, contact scrotal thermography and venography: A comparative study in evaluation of subclinical varicocele. Int J Fertil 1986;30(4):62-4.
118. Trum JW, Gubler FM, Laan R, et al. The value of palpation, varicoscreen contact thermography and colour Doppler ultrasound in the diagnosis of varicocele. Hum Reprod 1996;11(6):1232-5.
119. Fuse H, Nozaki T, Ohta S, et al. Sequential scrotal scintigraphy for the study of varicocele. Int Urol Nephrol 1999;31(4):511-7.
120. Minayoshi K, Okada H, Fujisawa M, et al. Hemodynamic evaluation of left testicular varicocele by scrotal scintigraphy. Eur Urol 2001;39(1):30-5.
121. Prenen JA, Van Dis P, Feijen HL. Varicocele scintigraphy: A simplified screening method for the detection of spermatic vein reflux. Clin Nucl Med 1996;21(12):921-7.
122. von Heijne A. Recurrent varicocele: Demonstration by 3D phase-contrast MR angiography. Acta Radiol 1997;38(6):1020-2.
123. Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril 1970;21(8):606-9.
124. Marks JL, McMahon R, Lipshultz LI. Predictive parameters of successful varicocele repair. J Urol 1986;136(3):609-12.
125. Steckel J, Dicker AP, Goldstein M. Relationship between varicocele size and response to varicocelectomy. J Urol 1993;149(4):769-71.
126. Yoshida K, Kitahara S, Chiba K, et al. Predictive indicators of successful varicocele repair in men with infertility. Int J Fertil Womens Med 2000;45(4):279-84.
127. Takahara M, Ichikawa T, Shiseki Y, et al. Relationship between grade of varicocele and the response to varicocelectomy. Int J Urol 1996;3(4):282-5.
128. Sandlow JI, Zenni M, Ehle J, Donovan Jr JF, Sparks AET. Size of varicocele corresponds with pregnancy rates following surgical treatment: Updated results. Fertil Steril 2000;74(Suppl):S87.
129. Sigman M, Jarow JP. Ipsilateral testicular hypertrophy is associated with decreased sperm counts in infertile men with varicoceles. J Urol 1997;158(2):605-7.
130. Schrepferman CG, Ehle J, Sparks AET, Donovan Jr JF, Sandlow JI. Preoperative total motile count (TMC) and follicle-stimulating hormone (FSH) are predictive of response to varicocelectomy. Fertil Steril 2000;74(Suppl):S240.
131. Matkov TG, Zenni M, Sandlow J, et al. Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy. Fertil Steril 2001;75(1):63-8.
132. Kadioglu A, Tefekli A, Cayan S, et al. Microsurgical inguinal varicocele repair in azoospermic men. Urology 2001;57(2):328-33.
133. Kim ED, Leibman BB, Grinblat DM, et al. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 1999;162(3 Pt 1):737-40.
134. Matthews GJ, Matthews ED, Goldstein M. Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil Steril 1998;70(1):71-5.
135. Matthews RD, Roberts J, Walker SA, et al. Migration of intravascular balloon after percutaneous embolotherapy of varicocele. Urology 1992;39(4):373-5.
136. Maurer B, Gromoll J, Simoni M, et al. Prevalence of Y chromosome microdeletions in infertile men who consulted a tertiary care medical centre: The Munster experience. Andrologia 2001;33(1):27-33.
137. Pryor JL, Kent-First M, Muallem A, et al. Microdeletions in the Y chromosome of infertile men. N Engl J Med 1997;336(8):534-9.
138. Moro E, Marin P, Rossi A, et al. Y chromosome microdeletions in infertile men with varicocele. Mol Cell Endocrinol 2000;161(1-2):67-71.
139. Brandell RA, Mielnik A, Liotta D, et al. Effect of partial Y chromosome deletions on results of treatment for severe male factor infertility [abstract O-021]. In: Program of the 16th World Congress on Fertility and Sterility & 54th Annual Meeting of the American Society for Reproductive Medicine. San Francisco; American Society for Reproductive Medicine; 1998. p. S9.
140. Cayan S, Lee D, Black LD, et al. Response to varicocelectomy in oligospermic men with and without defined genetic infertility. Urology 2001;57(3):530-55.
141. Jarow JP, Ogle SR, Eskew LA. Seminal improvement following repair of ultrasound detected subclinical varicoceles. J Urol 1996;155(4):1287-90.
142. McClure RD, Khoo D, Jarvi K, et al. Subclinical varicocele: The effectiveness of varicocelectomy. J Urol 1991;145(4):789-91.
143. Yarborough MA, Burns JR, Keller FS. Incidence and clinical significance of subclinical scrotal varicoceles. J Urol 1989;141(6):1372-4.
144. Marsman JW, Schats R. The subclinical varicocele debate. Hum Reprod 1994;9(1):1-8.
145. Unal D, Yeni E, Verit A, et al. Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: A prospective randomized study. Int J Urol 2001;8(5):227-30.
146. Palomo A. Radical cure of varicocele by a new technique: Preliminary report. J Urol 1949;61(3):604-7.
147. Ivanissevich O. Left varicocele due to reflux: Experience with 4470 operative cases in 42 years. J Int Coll Surg 1960;34(6):742-55.
148. Kramolowsky EV, Wood NL, Donovan JF, Sandlow JI. Randomized comparison of open versus laparoscopic varix ligation for the treatment of infertility. J Urol 1997;157(4):143.
149. Cayan S, Kadioglu TC, Tefekli A, et al. 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.
150. Goldstein M. Varicocelectomy: General considerations. In: Goldstein M, editor. Surgery of Male Infertility. 1st Edition. Philadelphia: WB Saunders; 1995. p. 169-72.
151. Iacono F, Capparelli G, Darmiento M. Bilateral varicocele repair by transscrotal extratunica vaginalis procedure in outpatients: A novel technique. Tech Urol 2000;6(3):196-200.
152. Rashid TM, Winfield HN, Lund GO, Troxel SA, Sandlow JI, Donovan JF. Comparative financial analysis of laparoscopic versus open varix ligation for men with clinically significant varicoceles. J Urol 1994;151:310A.
153. Lima SS, Castro MP, Costa OF. A new method for the treatment of varicocele. Andrologia 1978;10(2):103-6.
154. Iaccarino V. A nonsurgical treatment of varicocele: Trans-catheter sclerotherapy of gonadal veins. Ann Radiol (Paris) 1980;23(4):369-70.
155. Cornud F, Belin X, Amar E, et al. Varicocele: Strategies in diagnosis and treatment. Eur Radiol 1999;9(3):536-45.
156. Ferguson JM, Gillespie IN, Chalmers N, et al. Percutaneous varicocele embolization in the treatment of infertility. Br J Radiol 1995;68(811):700-3.
157. Kaufman SL, Kadir S, Barth KH, et al. Mechanisms of recurrent varicocele after balloon occlusion or surgical ligation of the internal spermatic vein. Radiology 1983;147(2):435-40.
158. Tauber R, Johnsen N. Antegrade scrotal sclerotherapy for the treatment of varicocele: Technique and late results. J Urol 1994;151(2):386-90.
159. Lenz M, Hof N, Kersting-Sommerhoff B, et al. Anatomic variants of the spermatic vein: Importance for percutaneous sclerotherapy of idiopathic varicocele. Radiology 1996;198(2):425-31.
160. Verhagen P, Blom JM, van Rijk PP, et al. Pulmonary embolism after percutaneous embolization of left spermatic vein. Eur Radiol 1992;15(3):190-2.
161. Chalmers N, Hufton AP, Jackson RW. Radiation risk estimation in varicocele embolization. Br J Radiol 2000;73(867):293-7.
162. Nieschlag E, Hertle L, Fischedick A, et al. Update on treatment of varicocele: Counseling as effective as occlusion of the vena spermatica. Hum Reprod 1998;13(8):2147-50.
163. Madgar I, Weissenberg R, Lunenfeld B, et al. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril 1995;63(1):120-4.
164. Pryor JL, Howards SS. Varicocele. Urol Clin North Am 1987;14(3):499-513.
165. Fazeli-Matin S, Morrison G, Goldstein M. What is the pregnancy rate in vasovasostomy and varicocelectomy patients who are "lost to follow-up?" J Urol 1994;151(Suppl 4):303A, no. 301.
166. Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? Urology 1997;49(1):83-90.
167. Noske HD, Weidner W. Varicocele - A historical perspective. World J Urol 1999;17(3):151-7.