Pathophysiology: None of the theories has been proved unquestionably, although an elevated heat effect caused by impaired circulation appears to be the most reproducible defect. Supporting this hypothesis is the fact that a varicocele created in an experimental animal led to poor sperm function with elevated intratesticular temperature. Although unproved, a varicocele may represent a progressive lesion that can have detrimental effects on testicular function.
Disease statistics: Varicoceles are found in: • 40% of infertile men • 20% of all men in the general population. The large majority are fertile with normal sperm. Urologists often diagnose and surgically repair varicoceles.
Treatment: Medical Therapy: No effective medical treatments for varicoceles have been identified. While some investigators are evaluating the role of antioxidants for the treatment of elevated levels of reactive oxygen species, this treatment approach is still experimental. Surgical Therapy: The primary form of treatment for varicoceles is surgery. The Primary goals of varicocele repair should include occlusion of the offending varicosity with high success, preservation of arterial flow to the testis, and the minimization of patient discomfort and morbidity.
Research: Many experts believe that the surgical repair of varicocele should be applied only in a meticulously selected group of infertile men, although there are no generally accepted criteria. Up to now, the only confirmed prognostic factor for achievement of pregnancy after varicocelectomy is the age of the female partner.