Afterword to varicocele and male infertility: current concepts and future perspectives

reviewed the evolution of diagnostic methods for varicocele identification. 2 The authors discussed the subjective nature of the clinical examination and the marked inter-observer variability in varicocele grading. Although physical examination still represents the gold standard for diagnosing clinically significant varicoceles, which are those with a clear indication for repair, the aforementioned authors commented how the less invasive radiologic methods have replaced the more invasive ones. The authors discussed the advantages and limitations of each diagnostic modality to detect and/or confirm varicocele and highlighted that advanced imaging methods such as magnetic resonance has potential applicability to detect early signs of testicular dysfunction that could lead to better selection of patients for varicocele repair. The following three articles provided provocative insights into the pathophysiology o f v a r i c o c e l e 3 – 5 A l t h o u g h s e v e r a l pathophysiological mechanisms have been proposed, current evidence supports oxidative stress as a key element in the pathophysiology of varicocele-related infertility. Three components have been shown to release reactive oxygen species (ROS) in men with varicocele under heat and hypoxic stress: the principal cells in the epididymis, the endothelial cells in the dilated pampiniform plexus and the testicular cells (developing germ cells, Leydig cells, macrophages, and peritubular cells). Excessive ROS has been associated with sperm DNA fragmentation (SDF), which may mediate the clinical manifestation of poor sperm function and infertility related to varicocele. Intrinsic mechanisms are available to counteract the actions of ROS that might explain why most men retain their fertility in the presence of varicocele. However, disruption of these protective antioxidant mechanisms may lead to impairment in sperm W e summarize and comment on the topics discussed by the contributors to this Special Issue of Asian Journal of Andrology. The scope of varicocele covers a wide spectrum, including proteomics and metabolomics, hormonal control, interventional therapy, and assisted reproductive technology (ART). The selection of topics demonstrates the exciting breadth of this thematic area and the opportunity research holds for both increasing the understanding and improv ing the reproductive health of males with varicocele. The first article of our special issue reviewed the epidemiology of varicocele and critically analyzed the reasons why its actual prevalence remains incompletely understood. 1 Whereas the prevalence of varicocele is low among boys aged 2–10, it becomes relatively high in adolescents and adults, …