Abstract：
The diagnosis of varicocele is clinical, carried out in supine and standing position and in Valsalva maneuver. Only clinical varicoceles have to be treated. A scrotal ultrasound with Doppler is generally performed as part of the infertile man\'s evaluation or in case of examination difficulties. The main indication for varicocele treatment is the adult man with clinical varicocele and abnormalities of sperm parameters, in a context of infertility of couple, with a partner having a satisfactory ovarian reserve and no cause of female infertility or a curable infertility cause. The decision to treat varicocele must therefore be taken after evaluation of the two partners of the couple. Adults with symptomatic varicocele and those with spermogram abnormalities may also be offered a cure for their varicocele even in the absence of a paternity plan, as well as adolescents with reduced testicular growth, an ipsilateral decrease testicular volume, or a size gradient between the 2 testes. The cure of varicocele can be carried out by surgery or by percutaneous embolization. Microsurgery (inguinal or subinguinal) offers lower rates of recurrence and complications than high surgical approaches (laparoscopic or not) and surgeries without magnification. It is therefore the reference surgical technique. Percutaneous retrograde embolization is a minimally invasive alternative to microsurgery offering satisfactory outcomes with rare and often benign complications. The cure for varicocele results in an improvement in sperm parameters and recent data seem to confirm that it increases the natural pregnancy rate. These results appear after a delay of 3 to 9 months (at least 1 to 2 cycles of spermatogenesis). When the sperm involvement was severe (azoospermia, severe oligospermia), the improvement of the spermogram allow (1) to avoid surgery testicular sperm extraction or (2) perform intrauterine insemination rather than ICSI.
摘要：
精索静脉曲张的诊断是临床，以仰卧和站立姿势以及Valsalva动作进行。只有临床精索静脉曲张必须治疗。具有多普勒的阴囊超声通常是作为不育男性评估的一部分或在检查困难的情况下进行的。精索静脉曲张治疗的主要适应症是临床精索静脉曲张和精子参数异常的成年男性，在夫妻不孕症的背景下，伴侣卵巢储备良好，没有女性不孕或可治愈的不孕原因。因此，治疗精索静脉曲张的决定必须在评估夫妇的两个伴侣之后做出。即使在没有亲子鉴定计划的情况下，有症状的精索静脉曲张和精子图异常的成年人也可以治愈精索静脉曲张。以及睾丸生长减少的青少年，同侧睾丸体积减少，或2个睾丸之间的大小梯度。精索静脉曲张的治疗可以通过手术或经皮栓塞进行。显微手术（腹股沟或腹股沟下）的复发率和并发症比高手术入路（腹腔镜或不腹腔镜）和无放大手术低。因此，它是参考手术技术。经皮逆行栓塞是显微外科手术的微创替代方案，可提供令人满意的结果，并伴有罕见且通常为良性的并发症。精索静脉曲张的治愈导致精子参数的改善，最近的数据似乎证实它增加了自然妊娠率。这些结果在延迟3至9个月（至少1至2个精子发生周期）后出现。当精子受累严重时（无精子症，严重少精症），精子图的改善允许（1）避免手术睾丸精子提取或（2）进行宫腔内人工授精而不是ICSI。
