Varicocele treatment in the light of evidence-based andrology

Treatment of varicoceles became the most common treatment for male infertil ity merely on an empirical basis. However, in the age of evidence-based med icine it is surprising that only a few, and mainly recent, randomized contr olled clinical trials with relevant outcome parameters have been published to allow adequate judgement of treatment effectiveness. Moreover, difficult ies in study design could also be detected in most of these high-quality st udies. Despite these difficulties and in contrast to the majority of uncont rolled studies on varicocelectomy, metaanalysis of these randomized control led clinical studies involving 385 patients showed no significant treatment benefit and questions the common practice of varicocelectomy. Even the hig h-quality studies show conflicting results and therefore the topic of varic ocele treatment will remain controversial and further randomized clinical t rials should readdress this issue. For the time being, intervention by surg ical or angiographic occlusion of the spermatic vein cannot be recommended.