Lomboy Jason R, Coward Robert M
Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina.
Semin Intervent Radiol. 2016 Sep;33(3):163-9. doi: 10.1055/s-0036-1586143.
A varicocele is an abnormal dilatation and tortuosity of the veins of the spermatic cord. Although varicoceles are common in the general population and are frequently found on routine physical examinations, they represent the most common correctable cause of male factor infertility. Varicoceles are also often incidental findings on imaging studies, particularly scrotal ultrasound. Importantly, not all varicoceles should be treated equally (or at all), and basic guidelines on the evaluation and indications for treatment of adult varicoceles should be reviewed before counseling and treatment. A semen analysis should be obtained for any male patient of reproductive age considering intervention. The adolescent varicocele is managed much differently than the adult varicocele and remains a source of controversy. This review describes the clinical presentation and the evaluation of adult and pediatric varicoceles, and provides guidance on their diagnosis and workup. It also describes options for surgical repair and the success and complication rates associated with each surgical approach, ultimately supporting microsurgical subinguinal varicocele repair as the current surgical standard.
精索静脉曲张是精索静脉的异常扩张和迂曲。尽管精索静脉曲张在普通人群中很常见，且常在常规体格检查中被发现，但它们是男性因素不育最常见的可纠正病因。精索静脉曲张也常常是影像学检查中的偶然发现，尤其是阴囊超声检查。重要的是，并非所有精索静脉曲张都应同等对待（或根本无需治疗），在进行咨询和治疗之前，应复习关于成人精索静脉曲张评估和治疗指征的基本指南。对于任何考虑干预的育龄男性患者，都应进行精液分析。青少年精索静脉曲张的处理与成人精索静脉曲张有很大不同，并且仍然是一个有争议的问题。本综述描述了成人和儿童精索静脉曲张的临床表现及评估，并为其诊断和检查提供指导。它还描述了手术修复的选择以及每种手术方法的成功率和并发症发生率，最终支持显微外科腹股沟下精索静脉曲张修复作为当前的手术标准。
