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Varicocèle: physiopathologie et approches thérapeutiques

Pathophysiology of varicocele and therapeutic approach

Andrologie volume 12, pages 100–104 (2002)Cite this article

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La varicocèle est une affection fréquente chez l'homme infertile puisque son incidence est plus du double de celle de la population fertile du même âge. Elle a un effet délétère sur la croissance du testicule et sur la spermatogenèse. Il est d'autant plus important que la varicocèle est volumineuse. Cet effet s'aggrave avec le temps d'exposition à la varicocèle témoignant d'une évolutivité des lésions.

Il ne faut pas traiter systématiquement une varicocèle chez un patient infertile mais tenir compte des facteurs associés en cause dans l'infertilité aussi bien chez l'homme que chez la femme. Le traitement de la varicocèle semble améliorer les paramètres spermatiques et ce d'autant plus qu'elle est volumineuse (grade 2–3) et que le traitement est précoce (intérêt du dépistage chez l'adolescent).

Les causes évoquées à l'origine de l'altération de la fonction testiculaire du fait de la varicocèle peuvent être regroupées en 4 groupes: anomalies de l'axe hypothalamo-hypophyso-gonadique, lésion d'origine vasculaire (stase, obstruction), reflux de métabolites rénaux et surrénaux, élévation de la température scrotale.

Les perturbations du bilan hormonal et les troubles de la thermorégulation testiculaire semblent des éléments pronostiques importants qui pourraient probablement être pris en compte dans les indications thérapeutiques.

Abstract

Varicocele is a frequent disease in infertile men (30–40%) and has a harmful effect on growth of the testis and spermatogenesis, which deteriorates with increasing length of exposure to varicocele.

Clinical varicocele (grade 2 and 3), especially in younger patients, represents a logical indication for treatment of varicocele in infertile men. However, all causes of infertility (male and female factors) must be considered before treatment.

The main factors of failure of spermatogenesis are: hormonal disturbances (hypothalamo-hypophysogonadal status) and testicular thermoregulation anomalies. They should be considered to be prognostic factors for treatment.

References

  1. BELLOLI G., D'AGOSTINO S., ZEN F., IOVERNO E.: Fertility rates after successful correction of varicocele in adolescent and adulthood. Eur. J. Ped. Surg., 1995, 5: 216–218.

    Article  CAS  Google Scholar 

  2. BICKAL A., DICKSTEIN G.: Factors predicting the outcome of varicocele repair of subfertility: the value of the luteinizing hormone releasing hormone test. J. Urol., 1989, 142: 1230–1234.

    Google Scholar 

  3. CAMERON D.F., SNYDLE F.E., ROSS M.H., DRYLIE D.M.: Ultrastructural alterations in the adluminal testicular compartment in men with varicocele. Fertil. Steril., 1980, 33, 526–533.

    PubMed  CAS  Google Scholar 

  4. CAYAN S., LEE D., BLACK LD., REIJO PERA RA., TUREK P.: Response to varicocelectomy in oligospermic men with and without defined genetic infertility. Urol., 2001, 57: 530–535.

    Article  PubMed  CAS  Google Scholar 

  5. CHEVAL M.J., PURCELL M.H.: Deterioration of semen parameters over time in men with untreated varicocele: evidence of progressive testicular damage. Fertil. Steril., 1992, 57: 174–77.

    Google Scholar 

  6. FONTAINE E., BENOIT G., JARDIN A., BEURTON D.: Varicocele: physiopathologie et approches cliniques. Progrès en Urologie, 2000, 10, 1099–1107.

    PubMed  CAS  Google Scholar 

  7. GONZALES G.F., GARCIA-HJARLES M.A.: Blood and seminal serotonin levels in infertile men with varicocele. Arch. Androl., 1990, 24: 193–195.

    Article  PubMed  CAS  Google Scholar 

  8. GORELICK J.L., GOLDSTEIN M.: Loss of fertility in men with varicocele. Fertil. Steril., 1993, 59: 613–616.

    PubMed  CAS  Google Scholar 

  9. HADZISELIMOVIC F., HERZOG B., LIEBUNDGUT B., JENNY P., BUSER M.. Testicular and vascular changes in children and adults with varicocele. J. Urol., 1989, 142: 583–585.

    PubMed  CAS  Google Scholar 

  10. HARRISON R.M., LEWIS R.W., ROBERTS J.A.: Pathophysiology of varicocele in nonhuman primates: long term seminal and testicular changes. Fertil. Steril., 1986, 46: 500–510.

    PubMed  CAS  Google Scholar 

  11. HUDSON R.W.: The endocrinology of varicocele. Fertil. Steril., 1988, 49: 199–208.

    PubMed  CAS  Google Scholar 

  12. ISMAIL M.T., SEDOR J., IRSCH I.H.: Are sperm motion parameters influenced by varicocele ligation. Fertil. Steril., 1999, 71: 886–890.

    Article  PubMed  CAS  Google Scholar 

  13. JOHNSEN S.G., AGGER P.: Quantitative evaluation of testicular biopsies before and after operation after varicocele. Fertil. Steril., 1978, 29: 58–63.

    PubMed  CAS  Google Scholar 

  14. KANDEEL FR., SWERDLOFF R.S.: Role of temperature in regulation of spermatogenesis and the use of heating as a method for contraception. Fertil. Steril., 1988, 49: 1–23.

    PubMed  CAS  Google Scholar 

  15. KAUFMAN D.G., NAGLER H.M.: Significance and pathophysiology of the varicocele; current concepts. Semin. Reprod. Endocrinol., 1988, 6: 349–357.

    Article  Google Scholar 

  16. KIM ED., LEIBMAN BB., GRINBLOT DM., LIPSHULTZ LI.: Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J. Urol., 1999, 162: 737–740.

    Article  PubMed  CAS  Google Scholar 

  17. KLAIBER E.L., BROVERMAN D.M., POKOLY T.B.: Interrelationship of cigarette smoking, testicular in adolsecents and seminal fluid indexes. Fertil. Steril., 1987, 47: 481–486.

    PubMed  CAS  Google Scholar 

  18. LENZI A., GANDINI L., BAGOLAN P., NAHUM A., DONDERO F.: Sperm parameters after early left treatment. Fertil. Steril., 1998, 69: 347–349.

    Article  PubMed  CAS  Google Scholar 

  19. MATHEWS G.J., MATHEWS E.A., GOLDSTEIN M.: Induction of spermatogenesis and achievement of pregnancy after micro-surgical varicocelectomy in men with azoospermia and severe oligo-asthenospermia. Fertil. Steril., 1998, 70: 71–75.

    Article  Google Scholar 

  20. OKUYAMA A., NAKAMURA M., NAMIKI M., et al.: Surgical repair of varicocele at puberty: preventive treatment for fertility improvement. J. Urol., 1988, 139: 562–564.

    PubMed  CAS  Google Scholar 

  21. PLYMATE S.R., PAUISEN C.A., McLACHMAN R.: Relation of serum inhibin levels to serum follicle stimulating hormone and sperm production in normal men and men with varicocele. J. Clin. Endocr. Metab., 1992, 74: 859–864.

    Article  PubMed  CAS  Google Scholar 

  22. POZZA D., D'OTTAVIO G., MASCI P., COIA L., ZAPPAVIGNA D.: Left varicocele at puberty. Urol., 1983, 22: 271–274.

    Article  PubMed  CAS  Google Scholar 

  23. PRYOR J.L., HOWARD S.S.: Varicocele. Urol. Clin. North Am., 1987, 14: 499–513.

    PubMed  CAS  Google Scholar 

  24. RAJFER J., TUNER T.T., RIVERA S.et al.: The inhibition of testosterone biosynthesis following experimental varicocele in the rat. Biol. Reprod., 1987, 36: 933–937.

    Article  PubMed  CAS  Google Scholar 

  25. SCHATTE E.C., HIRSHBERG S.J., FALLICK M.L., LIPSHULTZ L.I., KIM E.D.: Varicocelectomy improves sperm strict morphology and motility. J. Urol., 1998, 160: 1338–1340.

    Article  PubMed  CAS  Google Scholar 

  26. SEGENREICH E., ISRAILOV S., SHMUELE J., NIV E., BANIEL J., LIVNE P.: Evaluation of the relationship between semen parameters, pregnancy rate of wives of infertile men with varicocele and gonadotropin releasing hormone test before and after varicocelectomy. Urol., 1998; 52: 853–857.

    Article  PubMed  CAS  Google Scholar 

  27. SIGMAN M., JAROW J.P.: Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles. J. Urol., 1997, 158: 605–607.

    Article  PubMed  CAS  Google Scholar 

  28. STEENO O., KNOPS J., DECLERCK L., ADIMOELJA A., VAN DE VOORDE E.: Prevention of fertility discorders by detection and treatment of varicocele at school and college age. Andrologia, 1976, 8: 47–53.

    PubMed  CAS  Google Scholar 

  29. TAKIHARA H., SAKATOKU J., COCKETT A.T.K.: The pathophysiology of varicocele in male infertility. Fertil. Steril., 1991, 55: 861–868.

    PubMed  CAS  Google Scholar 

  30. WENSE D.L., PEASTER M.L., KIMSL K.K., LEACH G.E., LAD P.M., ZIMMERN P.E.: Stimulated reactive oxygen species generation in the spermatozoa of infertile men. J. Urol., 1993, 149: 64–67.

    Google Scholar 

  31. WORLD HEALTH ORGANIZATION: The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil. Steril., 1992, 57: 1289–1293.

    Google Scholar 

  32. ZINI A., BUCKSPAM M., BERODINUCCI D., JARVI K.: The influence of clinical and subclinical varicocele of testicular volume. Fertil. Steril., 1997, 68: 671–674.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Service d'Urologie-Andrologie, CHU De Nîmes, Hôpital Gaston Doumergue, 5 Rue Hoche, 30029, Nimes Cédex 4

    Laurent Wagner

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Communication au XVIII0 Congrès de la Société d'Andrologie de Langue Française, Montpellier, 13–15 décembre 2001.

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Wagner, L. Varicocèle: physiopathologie et approches thérapeutiques. Androl. 12, 100–104 (2002). https://doi.org/10.1007/BF03034953

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Basic and Clinical Andrology

ISSN: 2051-4190