Varicocele repair for nonobstructive azoospermia.
OBJECTIVE
To evaluate the role of varicocelectomy in the management of patients with varicoceles and nonobstructive azoospermia and to review predictors of successful outcomes.


RESULTS
Several small, retrospective, noncontrolled studies have documented return of sperm to the ejaculate in up to 56% of men with nonobstructive azoospermia (NOA) following varicocele repair. Additionally, a recent meta-analysis has reported a 6% spontaneous pregnancy rate in amongst NOA patients who underwent varicocele repair, regardless of surgical technique. Although these observations are promising, evidence for whether or not varicocele repair significantly improves spermatogenesis within an impaired testicle is conflicting. No clear predictors of success following varicocele repair have been identified, but a certain level of spermatogenesis on testicular biopsy appears to be necessary for a desirable outcome after varicocele repair.


CONCLUSIONS
The role of varicocelectomy for the treatment on NOA is controversial. Prospective, controlled studies are needed in order to define the true benefit of varicocele repair in men with NOA, in terms of improvement in semen parameters, testicular sperm retrieval rates, and pregnancy outcomes.
Department of Urology and Center for Male Reproductive Medicine and Surgery, Weill Cornell Medical College, New York, NY 10021, USA. akm9009@med.cornell.edu
Akanksha
A
Mehta
Marc
M
Goldstein
D053713:Azoospermia / Q000191:economics / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001706:Biopsy; D003362:Cost-Benefit Analysis; D005260:Female; D005298:Fertility; D017048:Health Care Costs; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D020127:Recovery of Function; D055101:Semen Analysis; D013091:Spermatogenesis; D013737:Testis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000191:economics; D014646:Varicocele / Q000150:complications / Q000191:economics / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*