Publication Cover
Human Fertility
an international, multidisciplinary journal dedicated to furthering research and promoting good practice
Volume 26, 2023 - Issue 6
269
Views
0
CrossRef citations to date
0
Altmetric
Review Articles

A review of the pathophysiology and evidence-based management of varicoceles and pelvic congestion syndrome

, &
Pages 1597-1608 | Received 31 Jul 2022, Accepted 25 Apr 2023, Published online: 16 May 2023

References

  • Akhmetzianov, R. V., & Bredikhin, R. A. (2021). Clinical efficacy of conservative treatment with micronized purified flavonoid fraction in female patients with pelvic congestion syndrome. Pain and Therapy, 10(2), 1567–1578. https://doi.org/10.1007/s40122-021-00312-6
  • Al-Hussaniy, H. A., Alburghaif, A. H., & Naji, M. A. (2021). Leptin hormone and its effectiveness in reproduction, metabolism, immunity, diabetes, hopes and ambitions. Journal of Medicine and Life, 14(5), 600–605. https://doi.org/10.25122/jml-2021-0153
  • Antignani, P. L., Lazarashvili, Z., Monedero, J. L., Ezpeleta, S. Z., Whiteley, M. S., Khilnani, N. M., Meissner, M. H., Wittens, C. H., Kurstjens, R. L., Belova, L., Bokuchava, M., Elkashishi, W. T., Jeanneret-Gris, C., Geroulakos, G., Gianesini, S., de Graaf, R., Krzanowski, M., Al Tarazi, L., Tessari, L., & Wikkeling, M. (2019). Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. International Angiology : a Journal of the International Union of Angiology, 38(4), 265–283. https://doi.org/10.23736/S0392-9590.19.04237-8
  • Banks, W. A., DiPalma, C. R., & Farrell, C. L. (1999). Impaired transport of leptin across the blood-brain barrier in obesity. Peptides, 20(11), 1341–1345. https://doi.org/10.1016/s0196-9781(99)00139-4
  • Bebars, G. A., Zaki, A., Dawood, A. R., & El-Gohary, M. A. (2000). Laparoscopic versus open high ligation of the testicular veins for the treatment of varicocele. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 4(3), 209–213.
  • Bedaiwy, M. A., Falcone, T., Goldberg, J. M., Sharma, R. K., Nelson, D. R., & Agarwal, A. (2006). Peritoneal fluid leptin is associated with chronic pelvic pain but not infertility in endometriosis patients. Human Reproduction (Oxford, England), 21(3), 788–791. https://doi.org/10.1093/humrep/dei376
  • Bittles, M. A., & Hoffer, E. K. (2008). Gonadal vein embolization: treatment of varicocele and pelvic congestion syndrome. Seminars in Interventional Radiology, 25(3), 261–270. https://doi.org/10.1055/s-0028-1085927
  • Borghi, C., & Dell’Atti, L. (2016). Pelvic congestion syndrome: the current state of the literature. Archives of Gynecology and Obstetrics, 293(2), 291–301. https://doi.org/10.1007/s00404-015-3895-7
  • Brown, C. L., Rizer, M., Alexander, R., Sharpe, E. E., 3rd,., & Rochon, P. J. (2018). Pelvic congestion syndrome: systematic review of treatment success. Seminars in Interventional Radiology, 35(1), 35–40. https://doi.org/10.1055/s-0038-1636519
  • Camargo, M., Ibrahim, E., Intasqui, P., Belardin, L. B., Antoniassi, M. P., Lynne, C. M., Brackett, N. L., & Bertolla, R. P. (2022). Seminal inflammasome activity in the adult varicocele. Human Fertility, 25(3), 548–556. https://doi.org/10.1080/14647273.2020.1870756
  • Cassidy, D., Jarvi, K., Grober, E., & Lo, K. (2012). Varicocele surgery or embolization: Which is better? Canadian Urological Association Journal = Journal de L'Association Des Urologues du Canada, 6(4), 266–268. https://doi.org/10.5489/cuaj.11064
  • Chevallier, O., Fauque, P., Poncelet, C., Guillen, K., Comby, P. O., Astruc, K., Barberet, J., Falvo, N., Simon, E., & Loffroy, R. (2021). Relevant biological effects of varicocele embolization with N-butyl cyanoacrylate glue on semen parameters in infertile men. Biomedicines, 9(10), 1423. https://doi.org/10.3390/biomedicines9101423
  • Chiba, K., Ramasamy, R., Lamb, D. J., & Lipshultz, L. I. (2016). The varicocele: diagnostic dilemmas, therapeutic challenges and future perspectives. Asian Journal of Andrology, 18(2), 276–281. https://doi.org/10.4103/1008-682X.167724
  • Childs, G. V., Odle, A. K., MacNicol, M. C., & MacNicol, A. M. (2021). The importance of leptin to reproduction. Endocrinology, 162(2), bqaa204. https://doi.org/10.1210/endocr/bqaa204
  • Dabbs, E. B., Dos Santos, S. J., Shiangoli, I., Holdstock, J. M., Beckett, D., & Whiteley, M. S. (2018). Pelvic venous reflux in males with varicose veins and recurrent varicose veins. Phlebology, 33(6), 382–387. https://doi.org/10.1177/0268355517728667
  • De Rose, A. F., Gallo, F., Giglio, M., Parisini, B., & Carmignani, G. (2003). Early use of menotropin in the treatment of varicocele [Early use of menotropin in the treatment of varicocele]. Archivio Italiano di Urologia, Andrologia: organo Ufficiale [di] Societa Italiana di Ecografia Urologica e Nefrologica, 75(1), 53–57.
  • Dubin, L., & Amelar, R. D. (1970). Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertility and Sterility, 21(8), 606–609. https://doi.org/10.1016/s0015-0282(16)37684-1
  • Dubin, L., & Hotchkiss, R. S. (1969). Testis biopsy in subfertile men with varicocele. Fertility and Sterility, 20(1), 50–57. https://doi.org/10.1016/S0015-0282(16)36904-7
  • Farquhar, C. M., Rogers, V., Franks, S., Pearce, S., Wadsworth, J., & Beard, R. W. (1989). A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion. British Journal of Obstetrics and Gynaecology, 96(10), 1153–1162. https://doi.org/10.1111/j.1471-0528.1989.tb03190.x
  • Fereydooni, A., & Stern, J. R. (2021). Contemporary treatment of May-Thurner Syndrome. The Journal of Cardiovascular Surgery, 62(5), 447–455. https://doi.org/10.23736/S0021-9509.21.11889-0
  • Fujisawa, M., & Ishikawa, T. (2003). Soluble forms of Fas and Fas ligand concentrations in the seminal plasma of infertile men with varicocele. The Journal of Urology, 170(6 Pt 1), 2363–2365. https://doi.org/10.1097/01.ju.0000095326.78152.a2
  • Garg, H., & Kumar, R. (2016). An update on the role of medical treatment including antioxidant therapy in varicocele. Asian Journal of Andrology, 18(2), 222–228. https://doi.org/10.4103/1008-682X.171657
  • Gat, Y., Gornish, M., Navon, U., Chakraborty, J., Bachar, G. N., & Ben-Shlomo, I. (2006). Right varicocele and hypoxia, crucial factors in male infertility: fluid mechanics analysis of the impaired testicular drainage system. Reproductive Biomedicine Online, 13(4), 510–515. https://doi.org/10.1016/s1472-6483(10)60638-4
  • Gavrilov, S. G. (2017). Vulvar varicosities: diagnosis, treatment, and prevention. International Journal of Women’s Health, 9, 463–475. https://doi.org/10.2147/IJWH.S126165
  • Gavrilov, S. G., & Lebedev, I. S. (2019). Is the endovascular embolization of tributaries of the internal iliac veins essential in the treatment of isolated pelvic-perineal reflux? Current Medical Research and Opinion, 35(1), 27–31. https://doi.org/10.1080/03007995.2018.1498781
  • Gavrilov, S. G., & Turischeva, O. O. (2017). Conservative treatment of pelvic congestion syndrome: indications and opportunities. Current Medical Research and Opinion, 33(6), 1099–1103. https://doi.org/10.1080/03007995.2017.1302414
  • Gavrilov, S., Karalkin, A., Mishakina, N., Efremova, O., & Grishenkova, A. (2022). Relationships of pelvic vein diameter and reflux with clinical manifestations of pelvic venous disorder. Diagnostics, 12(1), 145. https://doi.org/10.3390/diagnostics12010145
  • Gavrilov, S. G., Karalkin, A. V., Moskalenko, Y. P., & Grishenkova, A. S. (2021). Efficacy of two micronized purified flavonoid fraction dosing regimens in the pelvic venous pain relief. International Angiology : a Journal of the International Union of Angiology, 40(3), 180–186. https://doi.org/10.23736/S0392-9590.21.04579-X
  • Gavrilov, S. G., Mishakina, N. Y., Vasilyiev, A. V., & Kirsanov, K. V. (2023). Retrospective analysis of complications after gonadal vein interventions for pelvic venous disorder. The Journal of Surgical Research, 283, 249–258. https://doi.org/10.1016/j.jss.2022.10.062
  • Gavrilov, S. G., Moskalenko, Y. P., & Karalkin, A. V. (2019). Effectiveness and safety of micronized purified flavonoid fraction for the treatment of concomitant varicose veins of the pelvis and lower extremities. Current Medical Research and Opinion, 35(6), 1019–1026. https://doi.org/10.1080/03007995.2018.1552043
  • Gavrilov, S., Moskalenko, Y. P., Mishakina, N. Y., Efremova, O. I., Kulikov, V. M., & Grishenkova, A. S. (2021). Stratification of pelvic venous reflux in patients with pelvic varicose veins. Journal of Vascular Surgery. Venous and Lymphatic Disorders, 9(6), 1417–1424. https://doi.org/10.1016/j.jvsv.2021.04.019
  • Gavrilov, S. G., Vasilieva, G. Y., Vasiliev, I. M., & Efremova, O. I. (2019). Calcitonin Gene-related peptide and substance P as predictors of venous pelvic pain. Acta Naturae, 11(4), 88–92. https://doi.org/10.32607/20758251-2019-11-4-88-92
  • Gavrilov, S. G., Vasilyev, A. V., Moskalenko, Y. P., & Mishakina, N. Y. (2020). Diagnostic value of pelvic venography in female patients with pelvic varicose veins and vulvar varicosities. International Angiology : a Journal of the International Union of Angiology, 39(6), 452–460. https://doi.org/10.23736/S0392-9590.20.04402-8
  • Gavrilov, S. G., Vassilieva, G. Y., Vasilev, I. M., & Grishenkova, A. S. (2020). The role of vasoactive neuropeptides in the genesis of venous pelvic pain: A review. Phlebology, 35(1), 4–9. https://doi.org/10.1177/0268355519855598
  • Gong, M., He, X., Zhao, B., Kong, J., Gu, J., & Su, H. (2021). Ovarian vein embolization with N-butyl-2 cyanoacrylate glubran-2® for the treatment of pelvic venous disorder. Frontiers in Surgery, 8, 760600. https://doi.org/10.3389/fsurg.2021.760600
  • Gorelick, J. I., & Goldstein, M. (1993). Loss of fertility in men with varicocele. Fertility and Sterility, 59(3), 613–616. https://doi.org/10.1016/S0015-0282(16)55809-9
  • Graif, M., Hauser, R., Hirshebein, A., Botchan, A., Kessler, A., & Yabetz, H. (2000). Varicocele and the testicular-renal venous route: hemodynamic Doppler sonographic investigation. Journal of Ultrasound in Medicine : official Journal of the American Institute of Ultrasound in Medicine, 19(9), 627–631. https://doi.org/10.7863/jum.2000.19.9.627
  • Green, E. D., Maffei, M., Braden, V. V., Proenca, R., DeSilva, U., Zhang, Y., Chua, S. C., Jr,Leibel, R. L., Weissenbach, J., & Friedman, J. M. (1995). The human obese (OB) gene: RNA expression pattern and mapping on the physical, cytogenetic, and genetic maps of chromosome 7. Genome Research, 5(1), 5–12. https://doi.org/10.1101/gr.5.1.5
  • Greuner, D. A., & DeMarco, D. (2020). Current clinical management of pelvic congestion syndrome. Vascular Disease Management, 17(2), E23–E28.
  • Grinsted, J., Kjer, J. J., Blendstrup, K., & Pedersen, J. F. (1985). Is low temperature of the follicular fluid prior to ovulation necessary for normal oocyte development? Fertility and Sterility, 43(1), 34–39. https://doi.org/10.1016/s0015-0282(16)48314-7
  • Hale, B. J., Hager, C. L., Seibert, J. T., Selsby, J. T., Baumgard, L. H., Keating, A. F., & Ross, J. W. (2017). Heat stress induces autophagy in pig ovaries during follicular development. Biology of Reproduction, 97(3), 426–437. https://doi.org/10.1093/biolre/iox097
  • Heinz, A., & Brenner, E. (2010). Valves of the gonadal veins. An anatomical study. Phlebologie, 39(06), 317–324. https://doi.org/10.1055/s-0037-1622328
  • Hiromura, T., Nishioka, T., Nishioka, S., Ikeda, H., & Tomita, K. (2004). Reflux in the left ovarian vein: analysis of MDCT findings in asymptomatic women. AJR. American Journal of Roentgenology, 183(5), 1411–1415. https://doi.org/10.2214/ajr.183.5.1831411
  • Howard, F. M. (1993). The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstetrical & Gynecological Survey, 48(6), 357–387. https://doi.org/10.1097/00006254-199306000-00001
  • Johnson, D., & Sandlow, J. (2017). Treatment of varicoceles: techniques and outcomes. Fertility and Sterility, 108(3), 378–384. https://doi.org/10.1016/j.fertnstert.2017.07.020
  • Kehinde, B. A., Abolhassani, F., Yazdekhasti, H., Abbasi, N., Heydari, L., Daneshi, E., Rajabi, Z., Hamada, A., Agarwal, A., & Abbasi, M. (2016). The effects of unilateral varicose ovarian vein on antioxidant capacity and oocyte quality in rat ovary. Iranian Journal of Basic Medical Sciences, 19(8), 863–869.
  • Khant Aung, Z., Grattan, D. R., & Ladyman, S. R. (2020). Pregnancy-induced adaptation of central sensitivity to leptin and insulin. Molecular and Cellular Endocrinology, 516, 110933. https://doi.org/10.1016/j.mce.2020.110933
  • Khodamoradi, K., Khosravizadeh, Z., Seetharam, D., Mallepalli, S., Farber, N., & Arora, H. (2022). The role of leptin and low testosterone in obesity. International Journal of Impotence Research, 34(7), 704–713. https://doi.org/10.1038/s41443-022-00534-y
  • Khodamoradi, K., Parmar, M., Khosravizadeh, Z., Kuchakulla, M., Manoharan, M., & Arora, H. (2020). The role of leptin and obesity on male infertility. Current Opinion in Urology, 30(3), 334–339. https://doi.org/10.1097/MOU.0000000000000762
  • Kim, H. S., Malhotra, A. D., Rowe, P. C., Lee, J. M., & Venbrux, A. C. (2006). Embolotherapy for pelvic congestion syndrome: long-term results. Journal of Vascular and Interventional Radiology : JVIR, 17(2 Pt 1), 289–297. https://doi.org/10.1097/01.RVI.0000194870.11980.F8
  • Koo, S., & Fan, C. M. (2014). Pelvic congestion syndrome and pelvic varicosities. Techniques in Vascular and Interventional Radiology, 17(2), 90–95. https://doi.org/10.1053/j.tvir.2014.02.005
  • Kutsenko, O., McColgan, Y., & Salazar, G. (2021). Iliac vein stenosis: is the data strong enough for stenting in the young Pelvic Venous Disorders (PeVD) population? Techniques in Vascular and Interventional Radiology, 24(1), 100733. https://doi.org/10.1016/j.tvir.2021.100733
  • Laborda, A., Medrano, J., de Blas, I., Urtiaga, I., Carnevale, F. C., & de Gregorio, M. A. (2013). Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. Cardiovascular and Interventional Radiology, 36(4), 1006–1014. https://doi.org/10.1007/s00270-013-0586-2
  • Lee, J. D., Jeng, S. Y., & Lee, T. H. (2006). Increased expression of hypoxia-inducible factor-1alpha in the internal spermatic vein of patients with varicocele. The Journal of Urology, 175(3 Pt 1), 1045–1048; discussion 1048. https://doi.org/10.1016/S0022-5347(05)00417-9
  • Lee, J. D., Yang, W. K., & Lee, T. H. (2012). Increased expression of hypoxia-inducible factor-1alpha and Bcl-2 in varicocele and varicose veins. Annals of Vascular Surgery, 26(8), 1100–1105. https://doi.org/10.1016/j.avsg.2011.12.014
  • Lira Neto, F. T., Roque, M., & Esteves, S. C. (2021). Effect of varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele: a systematic review and meta-analysis. Fertility and Sterility, 116(3), 696–712. https://doi.org/10.1016/j.fertnstert.2021.04.003
  • Liu, J., Han, L., & Han, X. (2019). The Effect of a Subsequent Pregnancy After Ovarian Vein Embolization in Patients with Infertility Caused by Pelvic Congestion Syndrome. Academic Radiology, 26(10), 1373–1377. https://doi.org/10.1016/j.acra.2018.12.024
  • Lomboy, J. R., & Coward, R. M. (2016). The varicocele: Clinical presentation, evaluation, and surgical management. Seminars in Interventional Radiology, 33(3), 163–169. https://doi.org/10.1055/s-0036-1586143
  • Lopez, A. J. (2015). Female pelvic vein embolization: indications, techniques, and outcomes. Cardiovascular and Interventional Radiology, 38(4), 806–820. https://doi.org/10.1007/s00270-015-1074-7
  • Lundy, S. D., & Sabanegh, E. S. Jr (2018). Varicocele management for infertility and pain: A systematic review. Arab Journal of Urology, 16(1), 157–170. https://doi.org/10.1016/j.aju.2017.11.003
  • Meissner, M. H., & Gibson, K. (2015). Clinical outcome after treatment of pelvic congestion syndrome: sense and nonsense. Phlebology, 30(1 Suppl), 73–80. https://doi.org/10.1177/0268355514568067
  • Meissner, M. H., Khilnani, N. M., Labropoulos, N., Gasparis, A. P., Gibson, K., Greiner, M., Learman, L. A., Atashroo, D., Lurie, F., Passman, M. A., Basile, A., Lazarshvilli, Z., Lohr, J., Kim, M. D., Nicolini, P. H., Pabon-Ramos, W. M., & Rosenblatt, M. (2021). The Symptoms-varices-pathophysiology classification of pelvic venous disorders: A report of the American vein & lymphatic society international working group on pelvic venous disorders. Journal of Vascular Surgery. Venous and Lymphatic Disorders, 9(3), 568–584. https://doi.org/10.1016/j.jvsv.2020.12.084
  • Minhas, S., Bettocchi, C., Boeri, L., Capogrosso, P., Carvalho, J., Cilesiz, N. C., Cocci, A., Corona, G., Dimitropoulos, K., Gül, M., Hatzichristodoulou, G., Jones, T. H., Kadioglu, A., Martínez Salamanca, J. I., Milenkovic, U., Modgil, V., Russo, G. I., Serefoglu, E. C., Tharakan, T., Verze, P., … Salonia, A, EAU Working Group on Male Sexual and Reproductive Health. (2021). European association of urology guidelines on male sexual and reproductive health: 2021 update on male infertility. European Urology, 80(5), 603–620. https://doi.org/10.1016/j.eururo.2021.08.014
  • Nanavati, R., Jasinski, P., Adrahtas, D., Gasparis, A., & Labropoulos, N. (2018). Correlation between pelvic congestion syndrome and body mass index. Journal of Vascular Surgery, 67(2), 536–541. https://doi.org/10.1016/j.jvs.2017.06.115
  • Naughton, C. K., Nangia, A. K., & Agarwal, A. (2001). Pathophysiology of varicoceles in male infertility. Human Reproduction Update, 7(5), 473–481. https://doi.org/10.1093/humupd/7.5.473
  • Ni, K., Steger, K., Yang, H., Wang, H., Hu, K., & Chen, B. (2015). Expression and role of leptin under hypoxic conditions in human testis: organotypic in vitro culture experiment and clinical study on patients with varicocele. The Journal of Urology, 193(1), 360–367. https://doi.org/10.1016/j.juro.2014.06.072
  • Nöske, H. D., & Weidner, W. (1999). Varicocele–a historical perspective. World Journal of Urology, 17(3), 151–157. https://doi.org/10.1007/s003450050123
  • Park, S. J., Lim, J. W., Ko, Y. T., Lee, D. H., Yoon, Y., Oh, J. H., Lee, H. K., & Huh, C. Y. (2004). Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR. American Journal of Roentgenology, 182(3), 683–688. https://doi.org/10.2214/ajr.182.3.1820683
  • Persad, E., O'Loughlin, C. A., Kaur, S., Wagner, G., Matyas, N., Hassler-Di Fratta, M. R., & Nussbaumer-Streit, B. (2021). Surgical or radiological treatment for varicoceles in subfertile men. The Cochrane Database of Systematic Reviews, 4(4), CD000479. https://doi.org/10.1002/14651858.CD000479.pub6
  • Pietura, R., Toborek, M., Dudek, A., Boćkowska, A., Janicka, J., & Piekarski, P. (2013). Endovascular embolization of varicoceles using n-butyl cyanoacrylate (NBCA) glue. Polish Journal of Radiology, 78(2), 26–30. https://doi.org/10.12659/PJR.889181
  • Poyyamoli, S., Mehta, P., Cherian, M., Anand, R. R., Patil, S. B., Kalva, S., & Salazar, G. (2021). May-Thurner syndrome. Cardiovascular Diagnosis and Therapy, 11(5), 1104–1111. https://doi.org/10.21037/cdt.2020.03.07
  • Practice Committee of the American Society for Reproductive Medicine & Society for Male Reproduction and Urology. (2014). Report on varicocele and infertility: a committee opinion. Fertility and Sterility, 102(6), 1556–1560. https://doi.org/10.1016/j.fertnstert.2014.10.007
  • Pyra, K., Woźniak, S., Drelich-Zbroja, A., Wolski, A., & Jargiełło, T. (2016). Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results. Cardiovascular and Interventional Radiology, 39(8), 1122–1127. https://doi.org/10.1007/s00270-016-1380-8
  • Qiu, D., Shi, Q., & Pan, L. (2021). Efficacy of varicocelectomy for sperm DNA integrity improvement: A meta-analysis. Andrologia, 53(1), e13885. https://doi.org/10.1111/and.13885
  • Radaideh, Q., Patel, N. M., & Shammas, N. W. (2019). Iliac vein compression: epidemiology, diagnosis and treatment. Vascular Health and Risk Management, 15, 115–122. https://doi.org/10.2147/VHRM.S203349
  • Reginald, P. W., Beard, R. W., Kooner, J. S., Mathias, C. J., Samarage, S. U., Sutherland, I. A., & Wadsworth, J. (1987). Intravenous dihydroergotamine to relieve pelvic congestion with pain in young women. Lancet (London, England), 2(8555), 351–353. https://doi.org/10.1016/s0140-6736(87)92380-4
  • Said, S. M., Gloviczki, P., Kalra, M., Oderich, G. S., Duncan, A. A., D Fleming, M., & Bower, T. C. (2013). Renal nutcracker syndrome: surgical options. Seminars in Vascular Surgery, 26(1), 35–42. https://doi.org/10.1053/j.semvascsurg.2013.04.006
  • Saleh, R. A., & Agarwal, A. (2002). Oxidative stress and male infertility: from research bench to clinical practice. Journal of Andrology, 23(6), 737–752.
  • Sayfan, J., & Adam, Y. G. (1978). Intraoperative internal spermatic vein phlebography in the subfertile male with varicocele. Fertility and Sterility, 29(6), 669–675. https://doi.org/10.1016/s0015-0282(16)43343-1
  • Schauer, I., Madersbacher, S., Jost, R., Hübner, W. A., & Imhof, M. (2012). The impact of varicocelectomy on sperm parameters: a meta-analysis. The Journal of Urology, 187(5), 1540–1547. https://doi.org/10.1016/j.juro.2011.12.084
  • Shah, R., Agarwal, A., Kavoussi, P., Rambhatla, A., Saleh, R., Cannarella, R., Harraz, A. M., Boitrelle, F., Kuroda, S., Hamoda, T. A.-A A.-M., Zini, A., Ko, E., Calik, G., Toprak, T., Kandil, H., Gül, M., Bakırcıoğlu, M. E., Parekh, N., Russo, G. I., … Colpi, G. M, Global Andrology Forum. (2023). Consensus and diversity in the management of varicocele for male infertility: results of a global practice survey and comparison with guidelines and recommendations. The World Journal of Men’s Health, 41(1), 164–197. https://doi.org/10.5534/wjmh.220048
  • Shokeir, T., Amr, M., & Abdelshaheed, M. (2009). The efficacy of Implanon for the treatment of chronic pelvic pain associated with pelvic congestion: 1-year randomized controlled pilot study. Archives of Gynecology and Obstetrics, 280(3), 437–443. https://doi.org/10.1007/s00404-009-0951-1
  • Song, Y., Xu, Y., Liang, Z., Yang, Y., & Liu, X. (2019). Lower body mass index and higher height are correlated with increased varicocele risk. Andrologia, 51(10), e13391. https://doi.org/10.1111/and.13391
  • Tiseo, B. C., Esteves, S. C., & Cocuzza, M. S. (2016). Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men. Asian Journal of Andrology, 18(2), 239–245. https://doi.org/10.4103/1008-682X.172639
  • Tsukanov, Y. T., Tsukanov, A. Y., & Levdanskiy, E. G. (2016). Secondary varicose small pelvic veins and their treatment with micronized purified flavonoid fraction. The International Journal of Angiology : official Publication of the International College of Angiology, Inc, 25(2), 121–127. https://doi.org/10.1055/s-0035-1570118
  • van der Vleuten, C. J., van Kempen, J. A., & Schultze-Kool, L. J. (2012). Embolization to treat pelvic congestion syndrome and vulval varicose veins. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 118(3), 227–230. https://doi.org/10.1016/j.ijgo.2012.04.021
  • Vanlangenhove, P., De Keukeleire, K., Everaert, K., Van Maele, G., & Defreyne, L. (2012). Efficacy and safety of two different n-butyl-2-cyanoacrylates for the embolization of varicoceles: a prospective, randomized, blinded study. Cardiovascular and Interventional Radiology, 35(3), 598–606. https://doi.org/10.1007/s00270-011-0188-9
  • Venbrux, A. C., Rudakov, L., Plass, A., Emmert, M. Y., & Ebner, A. (2014). A new occlusion device: application of the ArtVentive endoluminal occlusion system (EOS)–first in human clinical trial. Cardiovascular and Interventional Radiology, 37(1), 85–93. https://doi.org/10.1007/s00270-013-0626-y
  • Whiteley, M. S. (2017). Objective measurements of pelvic venous reflux and stratification of severity of venous reflux in pelvic congestion syndrome due to pelvic venous reflux. Current Medical Research and Opinion, 33(11), 2089–2091. https://doi.org/10.1080/03007995.2017.1332987
  • Whiteley, M. S., Dos Santos, S. J., Harrison, C. C., Holdstock, J. M., & Lopez, A. J. (2015). Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology, 30(10), 706–713. https://doi.org/10.1177/0268355514554638
  • Whiteley, M. S., Lewis-Shiell, C., Bishop, S. I., Davis, E. L., Fernandez-Hart, T. J., Diwakar, P., & Beckett, D. (2018). Pelvic vein embolisation of gonadal and internal iliac veins can be performed safely and with good technical results in an ambulatory vein clinic, under local anaesthetic alone - Results from two years’ experience. Phlebology, 33(8), 575–579. https://doi.org/10.1177/0268355517734952
  • Yang, D. M., Kim, H. C., Nam, D. H., Jahng, G. H., Huh, C. Y., & Lim, J. W. (2012). Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography. The British Journal of Radiology, 85(1014), e117–e122. https://doi.org/10.1259/bjr/79155839
  • Yasim, A., Resim, S., Sahinkanat, T., Eroglu, E., Ari, M., & Efe, E. (2013). Clinical and subclinical varicocele incidence in patients with primary varicose veins requiring surgery. Annals of Vascular Surgery, 27(6), 758–761. https://doi.org/10.1016/j.avsg.2012.07.031
  • Youssef, T., & Abdalla, E. (2015). Single incision transumbilical laparoscopic varicocelectomy versus the conventional laparoscopic technique: A randomized clinical study. International Journal of Surgery (London, England), 18, 178–183. https://doi.org/10.1016/j.ijsu.2015.04.048
  • Zhang, J., Jin, P. P., Gong, M., Yi, Q. T., & Zhu, R. J. (2018). Role of leptin and the leptin receptor in the pathogenesis of varicocele-induced testicular dysfunction. Molecular Medicine Reports, 17(5), 7065–7072. https://doi.org/10.3892/mmr.2018.8753

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.