Therapy in Oligozoospermia (Varicocele, Cryptorchidism, Inflammation, and Seminal Tract Infections)

Abstract

AbstractThe management of infertile men with varicocele is highly debated. Varicocele repair (VR) can be either surgical (varicolectomy) or through angiographic embolization. Surgical repair of varicocele includes open non-microsurgical techniques whether inguinal (Ivanissevich) or high retroperitoneal ligation (Palomo), open microsurgical techniques (inguinal or sub-inguinal) or laparoscopic. The accumulating evidence suggests that VR can improve conventional sperm parameters (sperm concentration, motility, and morphology), seminal oxidative stress, sperm DNA fragmentation, and serum testosterone concentrations.Treatment of cryptorchism is based on surgical correction. The surgical approach for palpable undescended testis is inguinal orchidopexy with eventual repair of concomitant hernia. Scrotal surgical approach is a viable alternative. For nonpalpable undescended testis, surgical approach can be open or laparoscopic, in one or two stages and possibly with spermatic vessel transection. In some cases, orchiectomy is required (testis abdominal localization, impossibility of mobilization or high neoplastic risk).Male accessory gland infections, including infection and/or inflammation of accessory glands (prostate, seminal vesicles, and Cowper’s glands), and male genital tract infections are characterized by the presence of an elevated number of leukocytes and/or pathogens in semen, together with inflammatory signs. Management is based on different antibiotic therapies.