Mechanisms of Disease

Despite ongoing extensive research on varicoceles, the exact mechanism(s) by which varicocele induces male infertility is not known. The most plausible mechanism is that varicocele induces scrotal hyperthermia and this results in defective spermato-genesis [4-6]. Studies have shown that elevations in scrotal temperature can impair spermatogenesis in patients with or without varicocele [7]. In support of this theory, external cooling of the scrotum has been associated with improved sperm parameters [8]. An additional mechanism by which varicocele may induce male infertility is the reflux of adrenal and renal metabolites into the spermatic veins. These metabolites have been shown to have a detrimental toxic effect on the testes and high levels of catecholamines [9], prostaglandins E and F [10], and adrenomedullin [11] have been reported in the internal spermatic vein of infertile patients with varicocele. Finally, venous stasis and hypoxia has also been implicated as a potential mechanism. Venous stasis and hypoxia may induce apoptosis and reactive oxygen species (ROS) generation at the testicular level with deleterious effects on spermatogenesis [12, 13],

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