Pathophysiology and Incidence of Varicocoeles in Men: what an Infertility Specialist Should Know"

Varicocoeles or dilation of the pampiniform plexus involves 15%of men.The etiology and pathogenesis of varicocoeles can not be explained by one theory.Valve dysfunction, ontogenic collateral formation and the nutcracker phenomenon appear to act synergistically. Hyperthermia, increased hydrostatic pressures and antisperm agents are suggested as possible causes for the pathophysiology of varicocoeles induced infertility.But the combination of patients lifestyles, genetic factors and the consequences of reflux into pampiniform plexus contribute to infertility. Though venography remains the gold standard, the combination of physical examination, color Doppler ultrasound and thermography has the highest sensitivity and specificity to diagnose a varicocoele.For infertility still search is there regarding strict criteria or grading, for deciding which patients might or may not benefit from treatment. This treatment of varicocoeles can be done using open surgical or percutaneous techniques. Treatment of varicocoeles of infertility is controversial, as most of men with varicocoeles remain fertile. Currently highest pregnancy rates were obtained by inguinal, or subinguinal microscopic surgery gave the highest pregnancy rates, and the lowest recurrence rates along with complication rates. But superselective glue embolization or sclerosing of the ISV are the best percutaneous alternatives and can be done as an out door patient basis under local anaesthesia, with faster return to normal activities than surgery.

Keywords: valve dysfunction; mutcracker phenomenon; hyperthermia; infertility; subinguinal microscopic surgery; superselective glue embolization.