Tuesday, July 31, 2012

Varicocele part 1 • Author: Wesley M White, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS


Background

A varicocele is a dilatation of the pampiniform venous plexus and the internal spermatic vein. Varicocele is a well-recognized cause of decreased testicular function and occurs in approximately 15-20% of all males and in 40% of infertile males. Understanding the significance of this anatomic abnormality in the infertile patient requires a brief review of the history, background, and current concepts of functional anatomy, as well as the methods and results of surgical repair.

History of the Procedure

Varicocele was first recognized as a clinical problem in the 16th century. Ambroïse Paré (1500-1590), the most celebrated surgeon of the Renaissance, described this vascular abnormality as the result of melancholic blood (introverted اﻻنطوائية and thoughtful مدروس). Barfield, a British surgeon, first proposed the relationship between infertility and varicocele in the late 19th century. Shortly thereafter, other surgeons reported that varicocele is associated with an arrest of sperm secretion and the subsequent restoration of fertility following repair. Through the early 1900s, reports by other surgeons continued to describe the association of varicocele with infertility.
In the 1950s, after a report of fertility following varicocele repair in an individual known to be azoospermic, the idea of surgically correcting varicoceles as a clinical approach to certain kinds of male infertility gained support among American surgeons. Research continued, leading to many published studies that associated varicoceles with impaired semen quality.
In these studies, researchers documented a recurrent pattern of low sperm count, poor motility, and predominance of abnormal sperm forms; this became known as the stress pattern of semen. Although not synonymous or specific to varicocele, the term suggests early evidence of testicular damage. Urologists then began to assess male infertility through the study of sperm, which are evaluated for count, percentage of motile forms, forward movement or motility, and morphology (shape or form); the semen is also evaluated.

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