■在母亲高龄的时代,关于辅助生殖技术(ART)精索静脉曲张修复治疗结果的确凿证据较少.精索静脉曲张的基础研究进展显着,但有许多临床相关观点需要讨论。
■根据我们2000多例显微外科精索静脉曲张修复的经验,我们专注于精索静脉曲张修复的有效性,病理生理学,手术方法,对艺术的贡献,精子DNA碎片,本综述旨在为精索静脉曲张的基础和临床研究确定更清晰的方向。
■用于精索静脉曲张修复的显微手术低位结扎术有望仍然是手术治疗的金标准。根据一些系统评价和荟萃分析的结果,关于显微外科精索静脉曲张修复在男性不育治疗中的疗效的负面意见几乎不存在。然而,关于手术适应症和有效性的大部分证据与精液参数或非ART妊娠率的改善有关.
■关于精索静脉曲张的病理生理学的进一步理解可能会通过综合遗传获得,转录组,以及使用人类血液和睾丸样本进行表观遗传分析,我们希望开发新的诊断方法和药物治疗。
UNASSIGNED: In an era of advanced maternal age, there is less conclusive evidence regarding the treatment outcomes of varicocele repair for assisted reproductive technology (ART). Progress in basic research on varicocele is notable whereas there are many clinically relevant points to discuss.
UNASSIGNED: Based on our experience with more than 2000 cases of microsurgical varicocele repair, we focused on the effectiveness of varicocele repair, pathophysiology, surgical approaches, contributions to ART, sperm DNA fragmentation, and varicocele-associated azoospermia in this review with the aim of identifying clearer directions for basic and clinical research on varicocele.
UNASSIGNED: Microsurgical low ligation for varicocele repair is expected to remain the gold standard for surgical therapy. Based on the findings from a number of systematic reviews and meta-analyses, negative opinions regarding the efficacy of microsurgical varicocele repair in male infertility treatment have become virtually nonexistent. However, the majority of evidence regarding surgical indications and effectiveness pertains to improvements in semen parameters or non-ART pregnancy rates.
UNASSIGNED: Further understandings regarding to pathophysiology of varicocele will likely be gained through comprehensive genetic, transcriptomic, and epigenetic analyses using blood and testicular samples from humans and we hope to develop new diagnostic methods and pharmacotherapy.