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World J Clin Urol. Nov 24, 2014; 3(3): 340-343
Published online Nov 24, 2014. doi: 10.5410/wjcu.v3.i3.340
Varicocele and infertility: Role of pressure flow dynamics
Khaleeq ur Rehman, Muhammad-Quaid Zaman, Habib ur Rehman, Hafsa Zaneb
Khaleeq ur Rehman, Department of Urology and Andrology, FMH College of Medicine and Dentistry, Lahore 54000, Pakistan
Muhammad-Quaid Zaman, Habib ur Rehman, Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
Hafsa Zaneb, Department of Anatomy and Histology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
Author contributions: All authors have contributed equally from planning to the completion of final draft.
Correspondence to: Dr. Khaleeq ur Rehman, MBBS, MS Urology, FECSM, Professor of Urology and Andrology, Department of Urology and Andrology, FMH College of Medicine and Dentistry, Shadman, Lahore 54000, Pakistan. khaleeqr@hotmail.com
Telephone: +92-30-08492949 Fax: +92-42-37570586
Received: April 28, 2014
Revised: August 11, 2014
Accepted: September 4, 2014
Published online: November 24, 2014
Processing time: 205 Days and 2.1 Hours
Abstract

Varicocele is prevalent in infertile individuals as well as in normal adolescents and adults. It has an increasing trend with growing age. Infertile individuals with varicocele, develop varying degrees of sperm abnormalities that range from mild to severe semen abnormalities, even azoospermia may develop. The main proposed features of these abnormalities are incompetence of one-way valves of the draining veins of testes, that allow backflow of blood into testes. This backflow produces abnormally high intra-testicular pressure and temperature, that has been confirmed by thermography and pressure estimation in various studies. Microsurgical varicocelectomy may reverse the pathologic effects on spermatogenesis in most patients, which points towards the cause and effect relationship of varicocele with testicular damage. We propose that the prolonged effect of gravity might or may not be the initiating factor for varicocele, as in our experience, around 1/4th of hypogonadotropic hypogonadism patients who had no varicocele before treatment, developed varicocele within 3 to 6 mo of treatment with gonadotropins. Occasionally varicocele is produced by “Nutcracker phenomenon”, which is compression of left renal vein between the abdominal aorta and superior mesenteric artery. The deleterious effects of varicocele may develop slowly, causing delayed secondary infertility or rapidly, leading to azoospermia or individual may be spared of damage due to unknown factors that need further research.

Keywords: Varicocele; Scrotal Doppler ultrasonography; Testicular blood flow; Pressure flow dynamics; Testes; Infertility; Oligospermia; Aesthenospermia

Core tip: Varicocele is prevalent in infertile individuals as well as in normal adolescents and adults. It has an increasing trend with growing age. Infertile individuals with varicocele, develop varying degrees of sperm abnormalities. Microsurgical varicocelectomy may reverse the pathologic effects in most patients, which points towards the cause and effect relationship of varicocele with testicular damage. The question as to how some individuals are spared of the deleterious effects of varicocele, needs further research.