What Causes Varicocele?
Numerous theories have been suggested for causation of Varicocele:
- Left testicular vein enters the left renal vein perpendicularly, or
- Long (8 – 10 cm) left testicular vein (aided by gravity), or
- Compression of left renal vein between aorta and superior mesenteric artery (‘nut cracker’ effect), or
Absence or incompetent valves in testicular vein.
However:Varicocele is however seen i) Bilaterally in 20% to 50% of men ii) Unilateral right-sided varicocele is noted in 15% of men. Besides iii) While all causes suggested are in the abdomen (high), dilated tortuous veins are identified only in the scrotal and inguinal region (low) up to the deep inguinal ring. Since he was unsatisfied with the existing theories of varicocele and the poor functional results of other types of varicocele surgery, Dr. Parag Shah put forth his theory of ‘Cremasteric Compartment Complex’. Surgery of cremasteric disruption with venous ligation based on the above theory gives excellent functional results.
Numerous theories have been suggested:
- Hyperthermia: Pooling of warm venous blood leading to impaired spermatogenesis (Heat Injury),
- Toxins: Increased concentration of metabolic waste products (Nitric oxide / reactive oxygen free radicals). Abnormal concentration of adrenal and renal substances.
- Hypoxia: Decreased availability of oxygen and nutrients.
- Hormonal Impairment: In the production and concentration of testosterone.
Varicocele indisputably is thus a significant factor in decreasing testicular function and deterioration of semen quality.