Kim Howard H, Goldstein Marc
Department of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College, New York, NY, USA.
Curr Opin Urol. 2008 Nov;18(6):608-12. doi: 10.1097/MOU.0b013e3283136493.
Adult varicocele presents a challenge for male reproductive specialists. We have yet to fully elucidate the pathophysiology of varicocele. The enigma of the varicocele, although a source of frustration for clinicians, has been a siren call for researchers as attested to by the substantial, if flawed body of literature on the topic. We critically review recent publications on varicocele.
Although yielding mixed results, studies this year have explored the potential relationship between oxidative stress and varicocele-associated infertility. In clinically focused research, one group tackled the contentious question of efficacy of surgical varicocele management. Building on the errors of prior meta-analyses, this study takes a fresh view on an old but vital topic. Finally, it is becoming clearer that varicocele affects Leydig cell function as well as seminiferous tubular function, and is a risk factor for androgen deficiency.
With exceptions, recent studies support a role for varicocelectomy in the management of infertile couples. In addition, evidence is accumulating that early repair of varicoceles, especially large varicoceles, may be effective in preventing future infertility and may be an effective treatment for androgen deficiency.
成人精索静脉曲张给男性生殖专家带来了挑战。我们尚未完全阐明精索静脉曲张的病理生理学。精索静脉曲张之谜虽然令临床医生感到沮丧，但正如关于该主题的大量（虽有缺陷）文献所证明的那样，一直吸引着研究人员。我们对近期关于精索静脉曲张的出版物进行了批判性综述。
尽管结果不一，但今年的研究探讨了氧化应激与精索静脉曲张相关性不育之间的潜在关系。在以临床为重点的研究中，一组研究解决了精索静脉曲张手术治疗效果这一有争议的问题。基于先前荟萃分析的错误，该研究对一个古老但重要的主题提出了新观点。最后，越来越清楚的是，精索静脉曲张会影响睾丸间质细胞功能以及生精小管功能，并且是雄激素缺乏的一个危险因素。
除个别情况外，近期研究支持精索静脉结扎术在不育夫妇治疗中的作用。此外，越来越多的证据表明，早期修复精索静脉曲张，尤其是大型精索静脉曲张，可能对预防未来不育有效，并且可能是治疗雄激素缺乏的有效方法。
