The history of varicocele: from antiquity to the modern ERA

Abstract

Men have most likely been affected by varicocele since the assumption of the upright position. In De Medicina, written during the first century AD, Celsus credits the Greeks with the first description of a varicocele, and he recorded his own acute observation: “The veins are swollen and twisted over the testicle, which becomes smaller”. Celsus himself is credited with the distinction between varicocele (dilation of surface veins) and “cirsocele” (dilation of deep veins). There has been a long history of treatment attempts and failures, some of which are remarkably strange, that have sometimes cul- minated in tragedy, as in the case of French professor Jacques-Mathieu Delpech (1772-1832). Although some questions regarding the etiopathology and treatment of varico- cele remain unanswered, a succession of more or less conservative attempts involving all medical cultures has been performed throughout history. The report by W.S. Tulloch in 1952 brought varicocele into the era of modern evidence-based medicine, and varicocele surgery finally progressed beyond the aim of merely relieving scrotal pain and swelling. From 1970 to 2000, varicocelectomies gained worldwide attention for the treatment of male infertility. Several innovative procedures to correct varicoceles began to appear in the world's literature as interventional radiology, microsurgery, laparoscopy, and robotics, while comprehensive review articles were also published on the subject of varicocelectomies. Microsurgery is nowadays used worldwide and it can be considered to be the gold standard for correcting infertility linked to varicocele.

Retroperitoneal high ligation versus subinguinal varicocelectomy: Effectiveness of two different varicocelectomy techniques on the treatment of painful varicocele

“…In 1949, Alejandro Palomo described retroperitoneal high ligation technique for varicocele repair (Marte, ). In 1992, the subinguinal varicocelectomy by microsurgical arterial and lymphatic sparing technique was described (Goldstein, Gilbert, Dicker, Dwosh, & Gnecco, ).…”

Fertility-enhancing male reproductive surgery: glimpses into the past and thoughts for the future

“…The initial recognition of varicocele as a pathologic condition can be traced back to ancient history. Though no specific mention of varicocele is encountered in the texts of antiquity, artistic depictions from the ancient Egyptians reveal men with scrotal swellings that are consistent with varicocele (8). Likewise, careful examination of the ancient Greek Riace bronze statues, dating back to the 5th century BCE, reveals that the left testicle is positioned lower than the right and has the slight appearance of a varicocele (9).…”

“…In the early modern era, varicocelectomy developed as a treatment for testicular atrophy or pain. Celsus is credited with the very first varicocele surgery in the first century CE (8). In his ''De Medicina,'' he described the use of both cautery and ligatures via a scrotal approach to varicocelectomy.…”

“…Soon thereafter, Claudius Galen used a hook to isolate and subsequently section the veins of the pampiniform plexus. Over the ensuing centuries, many surgeons and anatomists continued to perform varicocelectomy via scrotal approach with a number of modifications: Heurteloup, King, and others developed scrotal clamps; Vidal de Cassis isolated the vas deferens and ligated the varicose veins with two silver wires and an iron pin; Delpech applied touchwood mushroom, a sclerosing agent, to the exposed scrotal veins; and the scrotal window approach gained popularity in the 19th century, wherein a scrotal incision was made and the varicose packet was ligated with the use of two ligatures, anteriorly and posteriorly (8).…”

History of Varicocele Surgery

“…Серебряная проволока размещалась снаружи от варикозных вен, так чтобы последние оказались между стержнем и проволокой, которая закручивалась вокруг стержня, сдавливая сосуды (Рис 5). Скручивания повторялись каждый день, до тех пор, пока сосуды под компрессией не изъязвлялись, после чего стержень с проволокой могли быть свободно удалены из раны и лечение заканчивалось купированием воспалительного процесса [15,16].…”