Recent Trends in the Management of Varicocele
Abstract
1. Introduction
2. Materials and Methods
3. Potential Links Between Varicocele and Infertility
3.1. Genetic and Molecular Aspects
3.2. Seminal Fluid Analysis
3.3. Antisperm Antibodies
3.4. Sperm DNA Fragmentation (SDF)
4. Novel Trends in Diagnosis of Varicocele
4.1. Grey-Scale Colour Duplex Ultrasound
4.2. Shear-Wave Elastography
5. Novel Trends in the Management of Varicocele
5.1. Prognosis Assessment
5.1.1. Preoperative Hormonal Parameters
5.1.2. Results of Preoperative Ultrasound and Semen Analysis
5.1.3. Scoring Systems, Nomograms, and Inflammatory Markers in Outcome Prediction
5.2. New Indications of Varicocele Treatment
5.2.1. Non-Obstructive Azoospermia (NOA)
5.2.2. Medically Assisted Reproduction (MAR)
5.2.3. Hypogonadism
5.3. Novel Techniques and Methods in Varicocele Treatment
5.3.1. Stem Cell Therapy
5.3.2. Surgical Techniques
5.3.3. Antioxidant Treatment
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Abbreviations
ASA | Antisperm Antibodies |
AI | Artificial Intelligence |
AUA | American Urological Association |
AUC | Area Under the Curve |
ARTs | Assisted Reproductive Technologies |
ASRM | American Society for Reproductive Medicine |
CFTR | Cystic Fibrosis Transmembrane Conductance Regulator |
DNA | Deoxyribonucleic Acid |
EAU | European Association of Urology |
EAA | European Academy of Andrology |
ESUR-SPIWG | European Society of Urogenital Radiology-Scrotal and Penile Imaging Working Group |
FSH | Follicle-Stimulating Hormone |
hAFMSCs | Human Amniotic Fluid Mesenchymal Stromal Cells |
hAECs | Human Amniotic Epithelial Cells |
ICG | Indocyanine Green |
INSL-3 | Insulin-like 3 |
IUI | Intrauterine Insemination |
ICSI | Intracytoplasmic Sperm Injection |
LH | Luteinizing Hormone |
MAR | Medically Assisted Reproduction |
MLR | Monocyte-to-Lymphocyte Ratio |
miRNA | MicroRNA |
NOA | Non-Obstructive Azoospermia |
NLR | Neutrophil-to-Lymphocyte Ratio |
ROC | Receiver Operating Characteristic |
SDF | Sperm DNA Fragmentation |
SII | Systemic Immune-Inflammation Index |
SIRI | Systemic Inflammatory Response Index |
SRR | Sperm Retrieval Rate |
TMSC | Total Motile Sperm Count |
TPMSC | Total Progressively Motile Sperm Count |
VITOM | Video Telescopic Operating Microscope |
WHO | World Health Organization |
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Classification | Basis of Grading | Grade I | Grade II | Grade III | Grade IV | Grade V |
---|---|---|---|---|---|---|
Hirsch (1980) [28] | Reflux pattern | No spontaneous reflux, elicitable with Valsalva maneuver. | Intermittent spontaneous reflux. | Continuous spontaneous reflux. | - | - |
Sarteschi (1993) [27] | Vein diameter, reflux pattern | No dilated veins, only inguinal reflux during Valsalva maneuver. | Supra-testicular varicosities, reflux during Valsalva maneuver. | Peritesticular varicosities only in standing position, reflux during Valsalva maneuver. | Dilated veins in supine position, increasing in standing position and Valsalva, reflux at rest, increasing with during Valsalva maneuver, possible testicular hypotrophy. | Dilated veins in standing and supine position, reflux at rest, not increasing during Valsalva maneuver. |
EAA (Lotti, 2022) [29] | Vein diameter, reflux pattern | Dilated veins (>3 mm) at rest at the funicular region with retrograde venous flow absent/intermittent at rest and enhanced during Valsalva maneuver. | Dilated veins (>3 mm) at rest at the upper pole of the testis with retrograde venous flow absent/intermittent at rest and enhanced during Valsalva maneuver. | Dilated veins (>3 mm) at rest at the lower pole of the testis with retrograde venous flow absent/intermittent at rest and enhanced during Valsalva maneuver. | Dilated veins (>3 mm) at rest (irrespective of location but usually extending to the peritesticular region) with retrograde venous flow continuous at rest and enhanced during Valsalva maneuver. Possible testicular hypotrophy. | Dilated veins (>3 mm) at rest (irrespective of location, but usually extending to the peritesticular region) with retrograde venous flow continuous at rest and not increasing during Valsalva maneuver. |
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Takács, T.; Szabó, A.; Kopa, Z. Recent Trends in the Management of Varicocele. J. Clin. Med. 2025, 14, 5445. https://doi.org/10.3390/jcm14155445
Takács T, Szabó A, Kopa Z. Recent Trends in the Management of Varicocele. Journal of Clinical Medicine. 2025; 14(15):5445. https://doi.org/10.3390/jcm14155445
Chicago/Turabian StyleTakács, Tamás, Anett Szabó, and Zsolt Kopa. 2025. "Recent Trends in the Management of Varicocele" Journal of Clinical Medicine 14, no. 15: 5445. https://doi.org/10.3390/jcm14155445
APA StyleTakács, T., Szabó, A., & Kopa, Z. (2025). Recent Trends in the Management of Varicocele. Journal of Clinical Medicine, 14(15), 5445. https://doi.org/10.3390/jcm14155445