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Schlegel PN, Goldstein M.Vasectomy; in Goldstein M (ed): Surgery of Male Infertility. Philadelphia, Saunders, 1995, pp 35-45. Li S, Goldstein M, Zhu J, Huber D. The no-scalpel vasectomy. J Urol 1991; 145: 341-344. Kendrick JS, Gonzales B, Huber DH, Grubb GS, Rubin GL. Complications of vasectomies in the United States. J Fam Pract 1987; 25: 245-248. Linnet L. Clinical immunology of vasectomy and vasovasostomy. Urology 1983; 22: 101-114. Verhulst ???, Hoekstra JW. Paternity after bilateral vasectomy. Br J Urol 1999; 83: 280-282. Bedford JM, Zelikovsky G. Viability of spermatozoa in the human ejaculate after vasectomy. Fertil Steril 1979; 32: 460-463. Matthews GJ, Schlegel PN, Goldstein M. Patency following microsurgical vasoepididymostomy and vasovasostomy: temporal considerations. J Urol 1995; 154:2070-2073. Belker AM, Thomas AJ Jr, Fuchs EF, Konnak JW, Sharlip ID. Results of 1.469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol 1991; 145: 505-511. 9. Weidner W, Schroeder-Printzen I, Weiske WH, Haidl G and the BMFT Study Group for
Pavlovich CP, Schlegel PN. Fertility options after vasectomy: a cost effectiveness analysis. Fertil Steril 1997; 67: 133-141. 11. Kolettis PN, Thomas AJ Jr. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol 1997; 158: 467-470. SPECIAL PROBLEMS IN THE TREATMENT OF MALE INFERTILITY VARICOCELE Introduction Varicocele is a common abnormality (see above Andrological investigations and spermatology) with the following andrological implications: ? Failure of ipsilateral testicular growth and development ? Symptoms of pain and discomfort ? Infertility Classification The following classification of varicocele [1,2] is useful in clinical practice:
tests (finding of reflux on Doppler examination) [3] Grade 2: Palpable at rest, but not visible Grade 3: Visible and palpable at rest
The diagnosis of varicocele has been defined by the WHO [2]. The consensus is that diagnostic procedures and classification of a varicocele including analysis have to follow these accepted criteria [2].
1. Varicocele is a physical abnormality present in 2-22% of the adult male population [4,5]. It is more 2. The incidence of pain and discomfort associated with varicocele is 2-10% [7]. Treatment to relieve 3. The exact association between reduced male fertility and varicocele is unknown, but analysis of the 4. Two prospective randomized studies show increased ipsi- and contralateral testis growth in adolescents 5. A series of studies suggested that altered endocrine profiles in men with varicocele (exaggerated 6. Five prospective randomized studies of varicocele treatment in adults gave conflicting results [6,14-18],
7. There is one prospective randomized study of treatment of subclinical varicocele, which failed to 8. Analysis of the large WHO infertility study [21] indicates that there is an excess of couples where both
Several treatment modalities can be chosen (Table 10). The type of intervention is mainly dependent on the therapist's experience. The consensus is that although laparascopic varicocelectomy is feasible, it needs to be justified in terms of cost effectiveness. Date: 2016-06-12; view: 299
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