Rotker, K., & Sigman, M. (2016). Recurrent varicocele. Asian journal of andrology, 18(2), 229-33. https://doi.org/10.4103/1008-682X.171578
Rotker K, Sigman M. Recurrent varicocele. Asian journal of andrology. 2016;18(2):229-33. doi:10.4103/1008-682X.171578
Rotker, Katherine, and Mark Sigman. "Recurrent varicocele." Asian journal of andrology, vol. 18, no. 2, 2016, pp. 229-33.
For EndNote, Zotero or Mendeley:
Open access
No open license is recorded for this paper. Reuse terms are set by the publisher.
Open Access
Free full text on PubMed Central (PMC4770491)
RRM Academy Synopsis
Microsurgical repair gives the fewest varicocele recurrences
A 2016 review of varicocele surgery in infertile men found that microsurgical repair leaves far fewer recurrences than open or laparoscopic repair. It cites a meta-analysis of four randomized trials with 1015 men. About 2 in 100 cases recurred after microsurgery and about 14 in 100 after open surgery.
Key Findings
Pooled recurrence after varicocele repair in four randomized trials: 1.9% (10/518) with microsurgery, 13.7% (68/497) with open surgery, 17.2% (34/198) with laparoscopy.
Microsurgery produced significantly fewer recurrences than laparoscopy (OR = 0.12, 95%CI 0.06, 0.32) and than open surgery (OR = 0.13, 95%CI 0.07, 0.25).
An earlier systematic review found recurrence of 1.05% (0%–3.57%) after microsurgical approaches and 14.97% (7%–35%) after retroperitoneal high ligation (Palomo).
Venography in 19 of 19 men with recurrence showed a patent internal spermatic vein.
After repeat sub-inguinal varicocelectomy, 21/23 (91.3%) men had no recurrence at 1-year follow-up.
Interpretation
The authors searched PubMed in August 2015 and summarized published studies of varicocele repair. The pooled trial figures come from an earlier meta-analysis of men who had been infertile for more than 12 months with a palpable varicocele and abnormal semen. Three of those trials averaged 17.4 to 21 months of follow-up, and the fourth checked men at 4 and 12 months. For recurrent varicocele, the authors conclude that no ideal method can be identified, because no randomized trials exist.
RRM Context
The review reports varicocele in more than 30% of men seen for infertility. The authors call it a reversible cause of male factor infertility. Restorative reproductive medicine checks both partners for causes that can be corrected. Varicocele is one such cause in the male partner.
Our editorial summary of this paper, not the article's abstract.
Abstract
Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence rates, anatomic causes of recurrence, and methods of management of recurrent varicoceles. The PubMed database was evaluated using keywords "recurrent" and "varicocele" as well as MESH criteria "recurrent" and "varicocele." Articles were not included that were not in English, represented single case reports, focused solely on subclinical varicocele, or focused solely on a pediatric population (age <18). Rates of recurrence vary with the technique of varicocele repair from 0% to 35%. Anatomy of recurrence can be defined by venography. Management of varicocele recurrence can be surgical or via embolization.
