Prognosis

Varicocele treatment will fully eliminate more than 90% of varicoceles (98% if microscopic subinguinal approach is used).[30][47]

The recurrence rate varies depending on repair technique, as does the complication rate.[49][50]​ Complications include testicular atrophy and, more commonly, development of a postsurgical hydrocele.

Because adolescent varicoceles are typically corrected for testicular growth arrest, patients can expect a 50% to 80% chance of ipsilateral "catch-up" growth of the affected testis following surgery.[54] This may take up to 6 months.

Semen parameters and fertility

While surgical varicocelectomy is controversial, reviews that excluded men with subclinical varicoceles and normal semen parameters suggest that the procedure improves semen parameters in patients with palpable varicocele and abnormal semen parameters.[33]​​[46][49]​​​[62]

An improvement in semen parameters, particularly concentration and motility, can be seen with repair of any clinically palpable varicoceles.[33]​​[46]​​[49]​​ The degree of improvement, however, likely depends on the size of the varicocele.[59] Sperm can return to the ejaculate in 44% of men with nonobstructive azoospermia with a varicocele after surgical repair.[63] Repair of varicocele in patients with nonobstructive azoospermia may improve sperm retrieval rates and intracytoplasmic sperm injection outcomes.[63][64]​ Pregnancy rates in infertile couples where the male has a palpable varicocele are also improved; however, more evidence is required to assess the impact on live birth rates.[33][65]

In addition to optimizing a man’s semen parameters and paternity rate, surgical varicocelectomy can improve testosterone production and reduce sperm DNA damage.[49][66] One meta-analysis found that varicocele ligation reduced sperm DNA damage by a modest 3.37%.[67]

Systematic reviews have reported a significant increase in the clinical pregnancy and live birth rates in patients with treated versus untreated varicoceles undergoing intracytoplasmic sperm injection (ICSI).[56][57]

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