Pathophysiology and treatment options of varicocele: An overview

Abstract

Varicocele is the most common correctable cause for male infertility, but not all men with varicocele are affected equally by this condition. The pathophysiology of varicocele-induced fertility remains ill-defined. While evidence suggests that oxidative stress remains a central factor, other mechanisms likely include scrotal hyperthermia, reflux of metabolites, hypoxia and cadmium accumulation. Microsurgical varicocelectomy remains the gold standard treatment option for infertile men with a clinically palpable varicocele and abnormal semen parameters. Newer evidence suggests a potential role for antioxidant supplementation and a meaningful role of varicocelectomy for patients destined for ART to improve pregnancy outcomes.

Efficacy of varicocelectomy in primary infertile patients with isolated teratozoospermia. A retrospective analysis

“…Although the exact mechanism of action has not been fully demonstrated, it has been proven that varicoceles affect sperm concentrations, motility and morphology (Damsgaard et al., 2016; Su et al., 2020). Several studies have reported that treatment of varicocele leads to an improvement in semen quality (Barekat et al., 2016; Zhang et al., 2017).…”

An update on male infertility: Factors, mechanisms, and interventions

“…Varicocele: An Overview (Su, Farber, & Vij, 2020) We hope that the reader will appreciate this special issue in Andrologia and gain a better understanding of the potential pathophysiological, genetic, epigenetic, environmental, anatomic and proteomic causes of male infertility. The articles and questions posed by leading experts in the field of male infertility will hopefully stimulate further discussion and expand research in these important areas.…”

The Negative Impact of Varicocele on Basic Semen Parameters, Sperm Nuclear DNA Dispersion and Oxidation-Reduction Potential in Semen

“…In this aspect, varicocele, defined as an abnormal venous dilation of the pampiniform plexus, usually with blood reflux, is of exceptional importance because, according to European Association of Andrology (EAU) Guidelines from 2020, varicocele is the second most common cause of male infertility. In the general population, approximately 15% of adult men have varicoceles, but in the population of infertile men, the prevalence rises to 40% (primary infertility) or even to 80% (secondary infertility) [ 4 , 5 , 6 , 7 , 8 ]. Therefore, proper medical examination of the scrotum is essential for the management of male infertility [ 4 , 5 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

“…The hypotheses assume that the causes may include hypoplasia of the developing male gonad in adolescence, congenital/acquired valve defects, venous obstruction, and anatomical variations [ 8 , 18 , 19 ]. Varicocele-related infertility is an effect of changes in testicular blood flow, including blood reflux and venous pressure, leading to scrotal hyperthermia, testicular hypoxia, endocrine disturbance, reflux and accumulation of toxic metabolites of adrenal or renal origin and testicular atrophy [ 7 , 8 , 20 , 21 , 22 , 23 ]. Moreover, most of these pathologies are linked with abnormal spermatogenesis and testicular oxidative stress (OS) resulting from an imbalance between pro- and antioxidative processes.…”