What causes Varicocele?

Numerous theories have been suggested:

  • Left testicular vein enters the left renal vein perpendicularly
  • Long (8 - 10 cm) left testicular vein (aided by gravity)
  • Compression of left renal vein between aorta and superior mesenteric artery ('nut cracker' effect)
  • Absence or incompetent valves in testicular vein

However

i) Varicocele is noted bilaterally in 20% to 50% of men

ii) Unilateral right-sided varicocele is noted in 15% of men

iii) While all causes suggested are in the abdomen (high), dilated tortuous veins are identified only in the scrotal and inguinal region (low) up to the deep inguinal ring.

Unsatisfied with the existing theories of varicocele and the poor functional results of varicocele surgery, Dr. Parag Shah put forth his theory of 'Cremasteric Compartment Complex'. Surgery of cremasteric disruption with venous ligation based on the above theory gives excellent functional results.

 

Undesirable effects

Numerous theories have been suggested

  1. Hyperthermia Pooling of warm venous blood leads to impaired spermatigenesis (Heat Injury).
  2. Toxins Increased concentration of metabolic waste products (Nitric oxide / reactive oxygen free radicals). Abnormal concentration of adrenal and renal substances.
  3. Hypoxia Decreased availability of oxygen and nutrients.
  4. Hormonal Impairment of testosterone production and concentration.

Cigarette smoking in presence of varicocele has a greatly adverse effect. Varicocele indisputably is a significant factor in decreasing testicular function and deterioration of semen quality.

Varicocele causes progressive duration-dependent injury of the seminiferous epithelium and testicular function.

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