Abstract
Varicocele is defined as an abnormal dilatation of the pampiniform plexus of the spermatic cord. This is seen in 10 to 20% of general population and is one of the most common correctable causes of male infertility. The history of varicocele dates back to the era of Ancient Greeks to about 600 BC, who had sculptured varicocele in their statues as a tortuous bag of wormsin the scrotum. It was Ambrose Pare who gave a poetic description to the pooling of blood in the spermatic cords and subsequently Curling coined the term Varicocele The intricacy of the venous drainage of the scrotum and its contents and the criss crossing of the veins makes the thermo-regulatory mechanism regulating spermatogenesis, even more complex. The Cremaster and Dartos greatly aid in facilitating the thermo-regulatory mechanism of scrotal wall, which forms the anatomical basis of oligospermia in patients with varicocele. Apart from a visible change in seminal parameters, the benefits of varicocelectomy have extended on to an improvement in serum testosterone and enhancement of erectile and ejaculatory functions. With a greater knowledge of the pathophysiology of varicocele and with better understanding of the roles of gene polymorphisms and reactive oxygen species, the indications for varicocelectomy gain more support and evidence. A sound anatomical knowledge and an in-depth understanding of the events that take place at molecular level might shift the treatment focus in future from varicocelectomy to molecular targeted therapies.
Highlights
IntroductionVaricocele is defined as an abnormal dilatation of the pampiniform plexus of the spermatic cord (that surrounds the testicles) and dilatation of the internal spermatic vein (1)
Varicocele is defined as an abnormal dilatation of the pampiniform plexus of the spermatic cord and dilatation of the internal spermatic vein (1)
The evaluation of varicocele has progressed from clinical to the molecular level, with multiple molecular factors that have been identified to play a significant role in sperm quality and fertility status in men with varicocele
Summary
Varicocele is defined as an abnormal dilatation of the pampiniform plexus of the spermatic cord (that surrounds the testicles) and dilatation of the internal spermatic vein (1). The dilated pampiniform plexus of veins of the scrotum resulting in oligospermia is one of the common and most important identifiable causes of male infertility (2). Various studies have shown a widespread prevalence of clinically detectable varicocele in 10 to 20% of the general population. This overall incidence doubles in infertile males and is seen in 25 to 40% of those with primary infertility and up to 80% of males with secondary infertility (3). The objective of this review is to discuss the evolution of concepts of varicocele from historical, anatomical, and urological perspectives
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