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O Impacto do Varicocele na Fertilidade Masculina
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Abstract(s)
Estima-se que a prevalência de infertilidade nos casais em idade reprodutiva seja de
cerca de 15%. O varicocele é amplamente reconhecido como uma condição relevante
clinicamente, uma vez que afeta significativamente a população masculina, constituindo
a causa mais comum de infertilidade masculina passível de ser corrigida. Esta condição
urológica benigna é caracterizada por uma alteração na varicosidade e tortuosidade das
veias do plexo venoso pampiniforme.
Julga-se que, diversos mecanismos possam estar na origem das alterações nos
parâmetros reprodutivos, provocadas por esta patologia, entre as quais, o aumento do
stress oxidativo, hipóxia testicular, hipertermia escrotal, acumulação de substâncias
tóxicas, alterações hormonais, disrupção da barreira hematotesticular e fenómenos de
autoimunidade, porém, estes não estão completamente esclarecidos.
A correção cirúrgica do varicocele é frequentemente realizada através de técnicas como
a varicocelectomia e tem como objetivo restaurar a função venosa e melhorar a qualidade
seminal e a fertilidade dos pacientes afetados. No entanto, a decisão da sua realização
deve ser baseada numa avaliação criteriosa da história clínica do paciente e dos seus
objetivos reprodutivos, considerando também as controvérsias sobre a real extensão dos
benefícios da mesma em diferentes contextos clínicos.
A complexidade do varicocele é, portanto, acentuada por uma série de conflitos na
literatura médica, que residem na compreensão dos mecanismos patofisiológicos
subjacentes e nas suas implicações na fertilidade masculina, bem como na eficácia e na
necessidade de intervenções terapêuticas, gerando um debate contínuo entre
especialistas na área. Por isso, é imperativo que mais estudos sejam realizados para
elucidar as controvérsias, nas quais esta condição está envolta.
A presente revisão de literatura analisa o impacto do varicocele na fertilidade masculina,
procurando compreender os mecanismos fisiopatológicos subjacentes e avaliar os
potenciais benefícios da correção cirúrgica do varicocele.
It is estimated that the prevalence of infertility in couples of reproductive age is around 15 per cent. Varicocele is widely recognised as a clinically relevant condition, as it significantly affects the male population and is the most common correctable cause of male infertility. This benign urological condition is characterised by an alteration in the varicosity and tortuosity of the veins of the pampiniform venous plexus. It is thought that various mechanisms may be at the root of the changes in reproductive parameters caused by this pathology, including increased oxidative stress, testicular hypoxia, scrotal hyperthermia, accumulation of toxic substances, hormonal changes, disruption of the haematotesticular barrier and autoimmune phenomena, but these are not fully understood. Surgical correction of varicocele is often carried out using techniques such as varicocelectomy and aims to restore venous function and improve seminal quality and fertility in affected patients. However, the decision to perform it must be based on a careful assessment of the patient's clinical history and reproductive goals, also taking into account the controversies over the real extent of its benefits in different clinical contexts. The complexity of varicocele is therefore accentuated by a series of conflicts in the medical literature, which lie in understanding the underlying pathophysiological mechanisms and their implications for male fertility, as well as the efficacy and necessity of therapeutic interventions, generating an ongoing debate among specialists in the field. It is therefore imperative that more studies are carried out to elucidate the controversies surrounding this condition. This literature review analyses the impact of varicocele on male fertility, seeking to understand the underlying pathophysiological mechanisms and assess the potential benefits of surgical correction of varicocele.
It is estimated that the prevalence of infertility in couples of reproductive age is around 15 per cent. Varicocele is widely recognised as a clinically relevant condition, as it significantly affects the male population and is the most common correctable cause of male infertility. This benign urological condition is characterised by an alteration in the varicosity and tortuosity of the veins of the pampiniform venous plexus. It is thought that various mechanisms may be at the root of the changes in reproductive parameters caused by this pathology, including increased oxidative stress, testicular hypoxia, scrotal hyperthermia, accumulation of toxic substances, hormonal changes, disruption of the haematotesticular barrier and autoimmune phenomena, but these are not fully understood. Surgical correction of varicocele is often carried out using techniques such as varicocelectomy and aims to restore venous function and improve seminal quality and fertility in affected patients. However, the decision to perform it must be based on a careful assessment of the patient's clinical history and reproductive goals, also taking into account the controversies over the real extent of its benefits in different clinical contexts. The complexity of varicocele is therefore accentuated by a series of conflicts in the medical literature, which lie in understanding the underlying pathophysiological mechanisms and their implications for male fertility, as well as the efficacy and necessity of therapeutic interventions, generating an ongoing debate among specialists in the field. It is therefore imperative that more studies are carried out to elucidate the controversies surrounding this condition. This literature review analyses the impact of varicocele on male fertility, seeking to understand the underlying pathophysiological mechanisms and assess the potential benefits of surgical correction of varicocele.
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Keywords
Diagnóstico Infertilidade Masculina Tratamento Varicocele