Варикоцеле: роль в развитии мужского бесплодия и методики хирургического лечения


DOI: https://dx.doi.org/10.18565/urology.2020.4.111-118

Н.Д. Ахвледиани, И.А. Рева, А.С. Чернушенко, А.Н. Берников, Д.Ю. Пушкарь

1) Кафедра урологии МГМСУ им. А. И. Евдокимова (зав. кафедрой – академик. РАН, профессор Д. Ю. Пушкарь), Москва, Россия; 2) Университетская клиника «Кусково» МГМСУ им. А. И. Евдокимова (директор – академик РАН, профессор В. В. Крылов), Москва, Россия
Варикоцеле – наиболее курабельная причина мужского бесплодия. Соответственно, оперативное лечение варикоцеле должно быть рекомендовано мотивированным пациентам и бесплодным парам, не имеющим других выявленных факторов инфертильности. Доказано, что коррекция варикоцеле улучшает параметры спермограммы и повышает шанс оплодотворения большинства пациентов. Однако хирургическое лечение связано с определенными рисками, в связи с чем выбор оптимального метода лечения остается предметом дискуссий.
Нами проведен анализ 78 статей с использованием базы данных MEDLINE (PubMed) с формированием обзора о текущих концептах функциональной анатомии артериальной и венозной систем яичка, в котором отражены актуальные рекомендации профессиональных сообществ касательно отбора пациентов для оперативного лечения варикоцеле и проанализированы литературные сведения об эффективности и безопасности различных методик оперативного лечения варикоцеле.
В представленном обзоре отражены противоречивость проблемы и имеющиеся литературные данные о показаниях к оперативному лечению варикоцеле, а также сопоставлены сведения об эффективности и безопасности паховой, лапароскопической и микрохирургической подпаховой техник хирургической коррекции варикоцеле. Сталкиваясь с диагнозом варикоцеле, специалист должен применять персонифицированный подход к каждому пациенту, обсуждая как преимущества, так и возможные побочные эффекты оперативного вмешательства. Из множества существующих методик, наиболее предпочтительно микрохирургическое лигирование вен семенного канатика.

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Об авторах / Для корреспонденции


А в т о р д л я с в я з и: Н. Д. Ахвледиани – д.м.н., профессор кафедры урологии МГМСУ им. И. М. Евдокимова,
Москва. Россия; e-mail: nikandro@mail.ru


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