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Vol. 44. Issue 5.
Pages 276-280 (June 2020)
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Vol. 44. Issue 5.
Pages 276-280 (June 2020)
Review article
Effect of varicocelectomy on fertility. Indications, techniques and results
Efecto de la varicocelectomía en la fertilidad. Indicaciones, técnicas y resultados
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M. Caradonti
Hospital Donación Francisco Santojanni, Ciudad Autónoma de Buenos Aires, Argentina
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Abstract

We define varicocele as the dilation of the veins that make up the pampiniform plexus, which is made up of three branches, the internal spermatic, deferential and external spermatic. The World Health Organization (WHO) has determined that varicocele is an important cause of male infertility. This has been acknowledged by several studies that have shown this cause–effect relationship. Varicocele does not always generate infertility. In fact, many patients with varicocele are fertile, decreasing their percentage in the progression of the pathology and the association with other factors such as tobacco, marijuana or endocrine disorders (diabetes or hypothyroidism). Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (WHO).

Surgical therapeutics

Surgery is indicated in cases of grade 3 varicocele (when seen through the scrotal skin and palpable as a ‘bag of worms’ without Valsalva maneuver), cases of atrophy or growth arrest with volume differences of more than 2cm3 between testes, when accompanied by pain and alterations in the spermiogram in young patients.

Conclusion

The presence of varicocele determines the performance of varicocelectomy, with the inguinal approach in its three branches being the approach of preference. The laparoscopic approach will be used in specific cases.

Keywords:
Varicocelectomy
Fertility
Varicocele
Spermiogram
Resumen

El varicocele lo definimos como la dilatación de las venas que conforman el plexo pampiniforme, el cual está constituido por 3 sistemas: el espermático, el deferencial y el funicular. La Organización Mundial de la Salud (OMS) ha determinado que el varicocele es una causa importante de infertilidad masculina, lo que se ha constatado a raíz de diferentes estudios que han puesto en evidencia esta relación causa-efecto. No siempre el varicocele genera infertilidad; muchos pacientes con varicocele son fértiles, disminuyendo su porcentaje en la progresión de la patología y la asociación con otros factores como el tabaco, la marihuana o endocrinopatías (diabetes o hipotiroidismo). La infertilidad es la incapacidad de una pareja sexualmente activa que no emplea métodos anticonceptivos de lograr el embarazo en el plazo de un año (OMS).

Terapéuticas quirúrgicas

La cirugía está indicada en casos de varicocele de grado 3 (cuando se observa a través de la piel del escroto y se palpa como «bolsa de gusanos» sin maniobra de Valsalva), casos de atrofia o detención en el crecimiento testicular con diferencias de volumen de más de 2cm3 entre ambos testículos, cuando se acompaña de dolor y existencia de alteraciones en el espermograma en pacientes jóvenes.

Conclusión

La presencia de varicocele es un determinante para la realización de la varicocelectomía, siendo el abordaje de preferencia a nivel inguinal, en sus 3 sectores. El abordaje laparoscópico se reserva para casos puntuales.

Palabras clave:
Varicocelectomía
Fertilidad
Varicocele
Espermograma

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