Varicocele and Male Infertility

Part I: Varicocele Origin and Pathology.- Anatomic theories of varicocele origin.- Scrotal hyperthermia, hormonal disturbances, testicular hypoperfusion, and backflow of toxic metabolites in varicocele.- Genetics and epigenetics of varicocele pathophysiology.- Oxidative stress and varicocele pathophysiology.- Proteomic and metabolomic profile of semen and seminal plasma in varicocele.- Experimental varicocele.- Part II: Clinical Evaluation of Varicocele.- Epidemiology of varicocele in pediatric, adolescent and adult populations.- Association between varicocele and infertility.- Varicocele clinical diagnosis and grading.- Imaging and other diagnostic modalities in varicocele diagnosis.- Conventional semen analysis and specialized sperm function tests in patients with varicocele.- Endocrine testing and the association between varicocele and hypogonadism.- Varicocele and orchialgia.- Part III: Therapy of Varicocele.- The evolution and refinement of varicocele treatment: A historical perspective.- Medical therapy in varicocele-related infertility.- Macroscopic surgical techniques for varicocele repair.- Microscopic surgical techniques for varicocele repair.- Laparoscopic techniques for varicocele repair.- Interventional radiology for varicocele treatment.- Robotic assisted microsurgical varicocelectomy.- Effect of varicocele treatment on conventional semen analysis.- Effect of varicocele treatment on oxidative stress markers and sperm DNA fragmentation.- Effect of varicocele treatment on natural pregnancy outcome.- Effect of varicocele treatment on assisted reproductive technology (ART) pregnancy outcome.- Varicocele and azoospermia.- Prognostic factors for a favorable outcome after varicocele repair in adults with infertility.- Management of recurrent varicocele.- Cost-effectiveness analysis of varicocele repair and assisted reproductive technology.- Management of pediatric and adolescent varicocele.- Part IV: Controversies with Varicocele.- Is varicocele a bilateral disease?- Why is subclinical varicocele considered a different entity?- Why is it that not all men with varicocele are infertile?- Is there a role for testicular biopsy in men with varicocele?- Should bilateral varicocele repair be recommended in cases of a clinical varicocele and contralateral subclinical varicocele?- Is there any role for intraoperative ultrasound during varicocele repair?- Is there any role for indocyanine green angiography in testicular artery preservation during microsurgical subinguinal varicocelectomy?- Should a varicocele be repaired before assisted reproductive technology treatment?- Should a varicocele be repaired in non-infertile patients with hypogonadism?- What should be the ideal control group in clinical trials investigating the role of varicocele and its treatment on fertility outcomes?- Part V: Debate (Pro and Con) over Varicocele.- Should SDF testing be used in men with varicocele?- Should varicocele be repaired before ART?- Should varicocele be repaired in azoospermic infertile men?- Should varicocele be managed surgically or radiographically?- Part VI: Clinical Case Scenarios Involving Varicocele.- Grade 1 varicocele and borderline/normal conventional semen analysis.- Grades 2/3 varicocele and normal conventional semen analysis.- Clinical varicocele and severely abnormal semen analysis in a couple considering ART whose female partner is over 36 years old.- Asymptomatic male with left grade 3 varicocele and 2 children desiring vasectomy with low testosterone.- Symptomatic male with subclinical varicocele found on ultrasound evaluation.- Recurrent grade 2/3 varicocele after microsurgical varicocelectomy and abnormal semen parameters in a couple attempting conception for >3 years.- Grade 2/3 varicocele in a 15-year-old healthy boy with normal testis volume (and normal semen analysis) with a history of varicocele and infertility in his father.- Part VII: Clinical Practice Guidelines for Varicocele.- Adult varicocele diagnosis and treatment.- Pediatric and adolescent varicocele diagnosis and treatment.- Sperm DNA fragmentation testing and varicocele.- Grade of evidence on varicocele treatment.- A 'Strengths-Weakness-Opportunities-Threats' (SWOT) analysis of varicocele-related infertility and its diagnosis and management.

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• Medicina reproductiva
• Urologia e medicina urológica

Assisted reproductive technology (ART);Azoospermia;Bilateral repair;Male infertility;Microsurgery;Orchialgia;Oxidative stress;Semen analysis;Semen quality;Seminal plasma;Sperm function testing;Subclinical varicocele;Urological surgery;Varicocele;Varicocelectomy;andrology