BMJ 2004;328:967-968 (24 April), doi:10.1136/bmj.328.7446.967
Editorial
Pathogenesis and treatment of varicoceles
Controversy still surrounds surgical treatment
| The first 150 words of the full text of this article appear below. |
The varicocele is an enigma in the treatment of male infertility. Despite over 30 years of evidence that repair of varicoceles results in improved fertility,1 the retrospective nature of most of these reports has led to controversy regarding the utility of treatment. This is compounded by the fact that not all varicoceles cause infertility. Varicocele is present in approximately 15% of men, and, although it is the most commonly diagnosed cause of male infertility, nearly two thirds of men with varicoceles remain fertile. The reason for this discrepancy remains unknown, although it is postulated that the cause of infertility is related to both temperature and time.2 The anatomical and physiological principles of the testicular vasculature and the evidence base regarding surgical treatment are outlined here.
The blood supply to the testis, as well as the resulting counter current heat exchange, results in cooler intratesticular temperatures compared with body temperature.3 Disruption
Jay Sandlow, associate professor
Department of Urology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 USA (jsandlow@mail.mcw.edu)
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- Varicocele
- Johannes L.H. Evers
bmj.com, 27 Apr 2004 [Full text] - Vericocele
- Amber D Porter
bmj.com, 29 Apr 2004 [Full text] - Re: Varicocele
- Jay I. Sandlow
bmj.com, 2 May 2004 [Full text] - The cause of infertility in varicocele
- Ibrahim A. Aziz
bmj.com, 6 May 2004 [Full text] - From a patient's perspective
- John Reynolds
bmj.com, 19 May 2004 [Full text] - From a Patient's Perspective
- John Reynolds
bmj.com, 2 Feb 2005 [Full text]
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