Varicocele: Anatomical Background and Uroradiological Aspects

Introduction: Varicocele is the dilatation of the pampiniform plexuses. It is a treatable cause of infertility. The incidence is higher in infertile men, ranging from 35-80%. Although various mechanisms are postulated for the formation of varicocele, the pathological mechanisms by which varicocele causes sperm dysfunction are oxidative stress, testicular hypoperfusion, and heat stress.

Anatomical aspects: 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.

Urological aspects: 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.

Conclusions: A sound anatomical knowledge and an indepth understanding of the events that take place at molecular level might shift the treatment focus in future from varicocelectomy to molecular targeted therapies.