Takács Tamás, Szabó Anett, Kopa Zsolt
Centre of Andrology, Department of Urology, Semmelweis University, 1082 Budapest, Hungary.
Centre of Assisted Reproduction, Department of Obstetrics and Gynaecology, Semmelweis University, 1082 Budapest, Hungary.
J Clin Med. 2025 Aug 2;14(15):5445. doi: 10.3390/jcm14155445.
Varicocele is a common, potentially correctable condition associated with impaired male fertility. Despite being frequently encountered in clinical andrology, its pathophysiological mechanisms, diagnostic criteria, and therapeutic approaches remain areas of active investigation and debate. The authors conducted a comprehensive literature search, using the PubMed database, covering clinical studies, systematic reviews, meta-analyses, and current international guidelines from the past ten years. Emphasis was placed on studies investigating novel diagnostic modalities, therapeutic innovations, and prognostic markers. Emerging evidence supports the multifactorial pathophysiology of varicocele, involving oxidative stress, hypoxia, inflammatory pathways, and potential genetic predisposition. Biomarkers, including microRNAs, antisperm antibodies, and sperm DNA fragmentation, offer diagnostic and prognostic utility, though their routine clinical implementation requires further validation. Advances in imaging, such as shear wave elastography, may improve diagnostic accuracy. While microsurgical subinguinal varicocelectomy remains the gold standard, technological refinements and non-surgical alternatives are being explored. Indications for treatment have expanded to include selected cases of non-obstructive azoospermia, hypogonadism, and optimization for assisted reproduction, though high-level evidence is limited.
精索静脉曲张是一种常见的、可能可纠正的与男性生育能力受损相关的病症。尽管在临床男科学中经常遇到，但它的病理生理机制、诊断标准和治疗方法仍然是积极研究和争论的领域。作者使用PubMed数据库进行了全面的文献检索，涵盖了过去十年的临床研究、系统评价、荟萃分析和当前国际指南。重点放在研究新型诊断方法、治疗创新和预后标志物的研究上。新出现的证据支持精索静脉曲张的多因素病理生理学，涉及氧化应激、缺氧、炎症途径和潜在的遗传易感性。生物标志物，包括微小RNA、抗精子抗体和精子DNA碎片化，具有诊断和预后价值，尽管它们在常规临床应用中需要进一步验证。成像技术的进步，如剪切波弹性成像，可能会提高诊断准确性。虽然显微外科腹股沟下精索静脉结扎术仍然是金标准，但正在探索技术改进和非手术替代方案。治疗指征已经扩大到包括某些非梗阻性无精子症、性腺功能减退病例以及辅助生殖的优化，尽管高级别证据有限。
