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Notice bibliographique
Résumé
There is no doubt that presence of varicocele contributes to testicular atrophy and decreased fertility in men [1]. There is also evidence that varicocelectomy improved quality of sperm and improve chances of pregnancy although some randomized controlled study were less impressive [2]. Obviously not every man with a significant varicocele has fertility issues or will benefit from varicocelectomy, but the odds favours performing surgery in these patients. It is still unclear through which mechanism varicocelectomy improves fertility. The possible options include decrease in hydrostatic pressure and venous reflex to the testis. There are also data indicating normalization of the testicular temperature and reduction in venous volume stabilize intratesticular testosterone metabolism (testicular proteins exhibit a reduced thermal stability) and improve spermatogenesis [3]. The present study of Bryniarski et al. [4] showed significant benefit of varicocelectomy for testicular growth with the initial hypotrophic testis using laparoscopic approach and confirming previous results in literature. The main advantage of this technique is optical magnification allowing preservation of lymphatics and testicular artery. The authors did not reported any complications with this technique, but it has to be remembered that although it is so called “minimal invasive”, it has its own complications and consequences. It increases cost of instrumentation and has infrequent but more serious complication including injury to the bowel or other organs, peritonitis or air embolism [5]. For that reason, microsurgical subinguinal technique which combines optical magnification for better exposure with easy and simple access, gains popularity [6]. It is also associated with less postoperative pain. It is still difficult to directly correlate improvement in testicular size to the improved sperm function or pregnancy rate. The present study would be more interesting if sperm quality and hormonal status was correlated to the grade of varicocele and tested after varicocelectomy. Indirectly, there were reports in literature, indicating that the sperm quality is inferior in a lot of patients with hypotrophic testis and with higher grade of varicocele. This improves after varicocelectomy [7]. The pregnancy rate increases only up to 50% after varicocelectomy, indicating that even with improved testicular size and/or sperm quality the pregnancy rate are far from optimal. It should be taken into consideration however that there are other factors influencing pregnancy rate equally on men and women site. There is also a question of possible beneficial effect of varicocelectomy on preventing development of late onset of hypogonadal state [8]. Confirmation of that statement obviously will require lengthy longitudinal population study. Varicocelectomy has its place in management of infertile men; however more studies are still required to fine tune evaluation, indication and technique of this intervention.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle