Abstract
A varicocele can be defined as an abnormal tortuosity and dilation of the veins of the pampiniform plexus. Idiopathic varicocele is usually asymptomatic. It is noticed as an asymmetry in scrotal size, and presents as heaviness in the scrotum, or rarely with testicular pain. In most cases the adolescent is unaware of the varicocele and it is discovered during a regular physical examination or during examination for military service. The incidence of high-grade varicocele is approximately 5 % throughout the world. Varicocele is associated with a time dependant growth arrest in adolescents and adult males. There is a clear association between varicocele, infertility and testicular growth arrest. It is also known that varicocelectomy can reverse testicular growth arrest in adolescents. These facts have raised the question of how to best manage the adolescents with a varicocele. Adolescents do not present with infertility and thus should prophylactic repair be performed to prevent infertility in the future? Who would benefit the most by varicocelectomy: the adolescents with testicular growth arrest or any adolescent with a varicocele? Is it better to wait for a semen analysis or offer earlier treatment based on testicular growth arrests? These questions can be only answered when we have better understanding of the pathophysiology of varicocele. The purpose of this review is to present the current literature on adolescent varicocele and provide guidelines to the clinician how to manage the adolescents with a varicocele.
Highlights
A varicocele can be defined as an abnormal tortuosity and dilation of the veins of the pampiniform plexus
The purpose of this review is to present the current literature on adolescent varicocele and provide guidelines to the clinician how to manage the adolescents with a varicocele
They concluded that testicular disruption associated with a varicocele is a phenomenon of the adluminal compartment, and that the Sertoli cell is more sensitive to perturbation of the testicular environment than are germ cells
Summary
A varicocele can be defined as an abnormal tortuosity and dilation of the veins of the pampiniform plexus. The pathophysiology of varicocele can be studied in animal models by partial ligation of the left renal vein.[35] Many features of the human condition, like increased temperature of the affected testis, increased arterial blood flow and histopathological changes can be replicated in animal models. Many of the enzymes responsible for optimal DNA synthesis in the testis are temperature dependent.[36,37] The scrotal position of the testis and the cooling system provided by the pampiniform plexus surrounding the testicular artery allows for heat exchange and is responsible for regulating optimal temperature for spermatogenesis.[38] Stasis of blood in the varicocele with resultant increased temperature may be responsible for the deleterious effect of varicocele on spermatogenesis.[39] Increased temperature is associated with decreased number of spermatogonia and increased apoptosis of germinal epithelium cells.[40]. Adrenal or renal metabolites at the level of the testis have not been documented.[35,45] Adrenalectomy done on rats with experimental varicocele did not diminish the effects of the varicocele.[46,47] the adrenal/renal reflux theory does not appear to be responsible for the testicular damage associated with varicocele.[46,48]
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