Prognosis

Varicocele treatment will fully eliminate more than 90% of varicoceles (98% if microscopic subinguinal approach is used).[31][47]

The recurrence rate varies depending on repair technique, as does the complication rate.[49][50]​ Complications include testicular atrophy and, more commonly, development of a post-surgical hydrocele.

Because adolescent varicoceles are typically corrected for testicular growth arrest, patients can expect a 50% to 80% chance of ipsilateral 'catch-up' growth of the affected testis following surgery.[55] This may take up to 6 months.

Semen parameters and fertility

While surgical varicocelectomy is controversial, reviews that excluded men with sub-clinical varicoceles and normal semen parameters suggest that the procedure improves semen parameters in patients with palpable varicocele and abnormal semen parameters.[34]​​[46][49]​​​[64]

An improvement in semen parameters, particularly concentration and motility, can be seen with repair of any clinically palpable varicoceles.[34]​​[46]​​[49]​​ The degree of improvement, however, likely depends on the size of the varicocele.[61] Sperm can return to the ejaculate in 44% of men with non-obstructive azoospermia with a varicocele after surgical repair.[65] Repair of varicocele in patients with non-obstructive azoospermia may improve sperm retrieval rates and intracytoplasmic sperm injection outcomes.[65][66]​ Pregnancy rates in infertile couples where the male has a palpable varicocele are also improved; however, more evidence is required to assess the impact on live birth rates.[34][67]

In addition to optimising a man’s semen parameters and paternity rate, surgical varicocelectomy can improve testosterone production and reduce sperm DNA damage.[49][68] One meta-analysis found that varicocele ligation reduced sperm DNA damage by a modest 3.37%.[69]

Systematic reviews have reported a significant increase in the clinical pregnancy and live birth rates in patients with treated versus untreated varicoceles undergoing intracytoplasmic sperm injection (ICSI).[57][58]

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