Tasks of surgical andrology in current interdisciplinary reproductive medicine.
Although the controversy about varicocele treatment options and their benefit has not been resolved, evidence is increasing that a cautious use of varicocele surgery contributes to effective management of male factor subfertility. Moreover, timely varicocele treatment might be an equally valuable prevention of later subfertility as early treatment of cryptorchidism. In reconstructive surgery of the ductal system, a more frequent use of tubulovasostomy can prevent initial failure. Furthermore, the cryopreservation of spermatic fluid for intracytoplasmic sperm injection can obviate a repeat procedure, if patency is not reached with surgery. The surgical andrologist is also the 'retriever' of sperm cells for assisted reproduction in cases of irreparable damage of the male reproductive organs. Efforts to delimit critically the indications and the results of the different techniques with large multicentre and interdisciplinary studies should be emphasized. Finally, it is encouraging that andrology does not rely solely on the successes and possibilities of assisted reproduction, but continues to inquire into the causes of male subfertility (e.g. by implementing immunohistochemical techniques into clinical research).
Denil
J
J
Urology Department, Hannover Medical School Medizinische Hochschule, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. denil.johan@mh-hannover.de