A Possible Ontogenic Etiology for Idiopathic Left Varicocele

Braedel, H. U.; Steffens, J.; Ziegler, M.; Polsky, M. Sheldon; Platt, Michael

doi:10.1016/s0022-5347(17)34872-3

Cited by 121 publications

(83 citation statements)

References 14 publications

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“…40,41 Investigations regarding the use of noninvasive sonographic imaging for the confirmation of the nutcracker phenomenon in children and adults have been performed previously. 10,11,[42][43][44] The scope of this study focused on quantitative description and hemodynamic evaluation of the LRV and on the presence of the nutcracker phenomenon (compression of the LRV between the aorta and superior mesenteric artery) 1,[4][5][6][7][9][10] to establish auxiliary diagnostic leads in the determination of the cause of varicocele using noninvasive sonography.…”

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confidence: 99%

Varicocele and Nutcracker Syndrome

Mohamadi

Ghasemi-Rad

Mladkova

et al. 2010

Journal of Ultrasound in Medicine

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Abbreviations AMP, aortomesenteric portion; ANOVA, analysis of variance; LRV, left renal vein lthough the causes of infertility in men are of various characters and origins (eg, developmental defects and exposure to harmful agents), a substantial proportion, especially secondarily infertile men, have the clinically detectable and correctable vascular abnormality varicocele.Despite various theories, the underlying cause of varicocele remains enigmatic. The role of intrinsic anatomic differences between the left and the right renal vein drainage systems has been implicated in the development of this condition. A greater length of the left internal spermatic vein in comparison with the right system and higher venous pressure on the left side caused by the junction of the left internal spermatic vein with the left renal vein (LRV) at a right angle are the most commonly considered factors because they lead to subsequent propagation of the elevated pressure to the left scrotal vein 1 and possibly determine the onset of varicocele. A ArticleObjective. Varicocele is a vascular lesion commonly associated with infertility. Its etiology is only partly understood; hence, the purpose of the study was to establish its correlation with intrinsic anatomic differences and nutcracker syndrome. Methods. A total of 93 patients with varicocele and 76 patients without varicocele were enrolled. The diagnosis of varicocele was based on physical examination, followed by sonographic evaluation of the hilar portion and aortomesenteric portion (AMP) of the left renal vein (LRV). The anteroposterior diameter in millimeters and peak flow in centimeters per second in each region were measured. Results. A total of 28 patients with the nutcracker syndrome were identified in the study group (30.10%), and 2 were identified in the control group (2.63%). The mean diameters of the hilar portion and AMP of the LRV were significantly different in varicocele-affected patients compared with the control group (P < .0001 for both). The mean peak velocities in the hilar portion and AMP were significantly different in patients with varicocele (P < .0001). Patients with varicocele and nutcracker syndrome did not have a significant difference in either the hilar or AMP diameter compared with patients with varicocele without nutcracker syndrome. They had a significant difference in both the hilar and AMP peak flow velocity (P = .0001 for both). Conclusions. Our findings indicate that nutcracker syndrome is a frequent finding in varicocele-affected patients and should be routinely excluded as a possible cause of varicocele. In addition, intrinsic anatomic differences in the AMP and hilar portion of the LRV could be directly responsible for the onset of varicocele.

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confidence: 99%

Varicocele and Nutcracker Syndrome

Mohamadi

Ghasemi-Rad

Mladkova

et al. 2010

Journal of Ultrasound in Medicine

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“…Proposed mechanisms include hypoxia and stasis, elevated testicular temperature, reflux of adrenal catecholamines, and increased oxidative stress. Scrotal temperature is maintained a few degrees below bodycore temperature in order to optimize the environment for normal testicular function by the countercurrent heat exchange first postulated by Dhal and Herrick in 1959 [11]. Impairment of testicular microcirculation has been proposed as a part of the pathologic effects of varicocele.…”

Section: Pathophysiology Of Varicocelementioning

confidence: 99%

“…A second theory is based on the observation that left internal spermatic vein lack functional valves which are more often absent on the left side than the right which can lead regression of blood. Braedel et al [11] demonstrated that the venographic pattern of 659 men with varicoceles showed that 73% of men had absent venous valves. Finally, a third theory suggests that there is partial obstruction of the left spermatic vein between the aorta and superior mesenteric artery ("the nutcracker phenomenon") [10].…”

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confidence: 99%

Varicocele and Male Infertility: Current Issues in Management-A Review

Sv¹

2014

Med Surg Urol

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Varicocele is the most common correctable cause of male factor infertility. The role of varicocele in the etiology of male infertility is still controversial regarding to whom varicocelectomy should be done and the selection should be meticulous. With the recent advances in biomolecular and development of novel sperm functional tests, it has been possible to better understand the mechanism involved in damage provoked by varicocele and therefore, propose ways to reverse them. Clinical studies have shown that varicocele surgery can improve semen quality sufficient to downgrade the type of assisted reproductive technology (ART) procedure required. This reveiw discusses current concepts on the mechanisms for varicocele induced testicular damage and efficacy of varicocelectomy for treatment of infertility. We also review the current guidelines and need for proper case selection before surgery.The authors critically reviewed the cost effectiveness of the surgical treatment of a varicocele compared with assisted reproductive techniques.

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“…The anatomic differences between the left and right internal spermatic vein (accounting for the predominance of left-sided varicocele), the incompetence of venous valves resulting in reflux of venous blood and increased hydrostatic pressure are the most popular theories. 17,18 Increased intraabdominal pressure during childhood and early adolescence may be a predisposing factor in the development of a varicocele. 19 …”

Section: Etiology Of Varicocelementioning

confidence: 99%

Varicocelectomy: microsurgical subinguinal versus inguinal technique

Zini

Binsaleh²,

Lo³

2012

CUAJ

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273POINT / COUNTERPOINT I t is reported that 35% to 40% of infertile men have a palpable varicocele (dilated testicular veins), whereas the prevalence of a varicocele in the general male population is about 15%.1-3 Although varicoceles have been associated with impaired male fertility potential, it is also clear that a significant proportion of men with a varicocele (about 75%) are fertile. 2,4,5 As such, a cause and effect relationship between varicocele and male infertility has not been conclusively established. 6 The effect of varicocelectomy on male fertility is also controversial.6-10 Uncontrolled studies have generally shown improved semen quality and pregnancy outcome after surgery.11 On the other hand, the results of randomized controlled studies of varicocelectomy for clinical varicocele (only a few such studies are published) are equivocal. [12][13][14][15] Despite the absence of clear evidence for a positive effect of varicocelectomy, many clinicians consider the data sufficient to support the practice of this surgery, and varicocele is the most commonly treated condition in men with infertility in North America. 8 The benefit of varicocele repair must be balanced by the risk associated with the procedure itself. As such, it is important to select the procedure with the highest success and lowest complication rate. Also, it is important to consider assisted reproductive technologies (ARTs) as an alternative to varicocelectomy in infertile couples. 16 Etiology of varicoceleThe etiology of varicocele is multifactorial. The anatomic differences between the left and right internal spermatic vein (accounting for the predominance of left-sided varicocele), the incompetence of venous valves resulting in reflux of venous blood and increased hydrostatic pressure are the most popular theories. 17,18 Increased intraabdominal pressure during childhood and early adolescence may be a predisposing factor in the development of a varicocele. 19 Mechanisms of varicocele-induced pathologyScrotal and intratesticular temperatures are elevated in humans and in experimental animal models with varicocele, and varicocelectomy may reduce testicular temperature. [20][21][22][23][24] Scrotal hyperthermia likely represents the primary factor by which a varicocele affects endocrine function and spermatogenesis, both sensitive to temperature elevation (testicular proteins exhibit a reduced thermal stability compared with proteins from other organs). [25][26][27] The detrimental effect of hyperthermia may also be exerted on the epididymis. 28 Experimental elevations in epididymal temperature reduce the storage capacity of this organ, resulting in decreased sperm count and quality in the ejaculate. 28Increased hydrostatic pressure in the internal spermatic vein from renal vein reflux may also be responsible for varicocele-induced pathology. Pathophysiology of varicoceleThe adverse effect of varicocele on male fertility is most clearly manifested by the testicular atrophy generally associated with this condition. 4 Using scrota...

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A Possible Ontogenic Etiology for Idiopathic Left Varicocele

Cited by 121 publications

References 14 publications

Varicocele and Nutcracker Syndrome

Varicocele and Nutcracker Syndrome

Varicocele and Male Infertility: Current Issues in Management-A Review

Varicocelectomy: microsurgical subinguinal versus inguinal technique

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