Abstract：
BACKGROUND: Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d\'urologie (AFU) Comité d\'andrologie et de médecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional information. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances.
METHODS: Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023.
RESULTS: Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery.
CONCLUSIONS: Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.
METHODS: Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023.
RESULTS: Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery.
CONCLUSIONS: Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.
摘要：
背景：精索静脉曲张是男性不育最常见的可纠正原因。这是最近法国泌尿外科协会（AFU）委员会（CAMS）建议的主题。从那以后,文献提供了更多信息。这篇综述将全面重新评估目前治疗精索静脉曲张的适应症。并根据当前的进展重新审视当代问题。
方法：作为2020年至2023年期间CAMS建议的一部分进行的文献检索的更新。
结果：对于临床精索静脉曲张和精子参数异常的不育男性，显微手术腹股沟下精索静脉曲张切除术仍然是首选的手术治疗方法。复发率低于4%。它显著提高了自然和体外受精活产和妊娠率，以及精子数量，总运动和渐进运动，形态学和DNA断裂率。总而言之，它在大约两种情况下的一种情况下修改了MPA策略。精索静脉曲张分级和双侧性可以预测精子参数和妊娠率的改善。不建议治疗亚临床精索静脉曲张。并发症很少见，特别是鞘膜积液（0.5%），单侧睾丸萎缩由于动脉损伤（1/1000），血肿,延迟愈合和术后疼痛。逆行栓塞是手术的替代方法。
结论：只要有可能，泌尿科医师应与MPA团队和患者一起提出并讨论精索静脉曲张的治疗方案，采取个性化的方法。
方法：作为2020年至2023年期间CAMS建议的一部分进行的文献检索的更新。
结果：对于临床精索静脉曲张和精子参数异常的不育男性，显微手术腹股沟下精索静脉曲张切除术仍然是首选的手术治疗方法。复发率低于4%。它显著提高了自然和体外受精活产和妊娠率，以及精子数量，总运动和渐进运动，形态学和DNA断裂率。总而言之，它在大约两种情况下的一种情况下修改了MPA策略。精索静脉曲张分级和双侧性可以预测精子参数和妊娠率的改善。不建议治疗亚临床精索静脉曲张。并发症很少见，特别是鞘膜积液（0.5%），单侧睾丸萎缩由于动脉损伤（1/1000），血肿,延迟愈合和术后疼痛。逆行栓塞是手术的替代方法。
结论：只要有可能，泌尿科医师应与MPA团队和患者一起提出并讨论精索静脉曲张的治疗方案，采取个性化的方法。
