I STOPPED WEARING UNDERPANTS IN 1971,
REALIZED THAT THEY DANGLE FOR THE PURPOSE
The presence of a varicocele is associated with elevated scrotal and testicular temperature and altered spermatogenesis.
Experimental studies have shown that spermatogenesis occurs optimally at temperatures lower than body temperature. Many of
the enzymes responsible for optimal DNA synthesis in the testis are temperature dependent.36,37 The scrotal position
of the testis and the cooling system provided by the pampiniform plexus surrounding the testicular artery allows for heat
exchange and is responsible for regulating optimal temperature for spermatogenesis.38 Stasis of blood in the varicocele
with resultant increased temperature may be responsible for the deleterious effect of varicocele on spermatogenesis.39
Increased temperature is associated with decreased number of spermatogonia and increased apoptosis of germinal epithelium
Darius A. Paduch
Steven J. Skoog
Division of Urology and Renal Transplantation
Oregon Health Sciences University, Portland,
A varicocele can be defined as an abnormal tortuosity and dilation of the veins of the pampiniform plexus. Idiopathic varicocele
is usually asymptomatic. It is noticed as an asymmetry in scrotal size, and presents as heaviness in the scrotum, or rarely
with testicular pain. In most cases the adolescent is unaware of the varicocele and it is discovered during a regular physical
examination or during examination for military service.1-4
The incidence of high-grade varicocele is approximately 5 % throughout the world.5 Varicocele is associated
with a time dependant growth arrest in adolescents and adult males.6 There is a clear association between varicocele,
infertility and testicular growth arrest.7-9 It is also known that varicocelectomy can reverse testicular growth
arrest in adolescents.10-13 These facts have raised the question of how to best manage the adolescents with a varicocele.
Adolescents do not present with infertility and thus should prophylactic repair be performed to prevent infertility in
the future? Who would benefit the most by varicocelectomy: the adolescents with testicular growth arrest or any adolescent
with a varicocele? Is it better to wait for a semen analysis or offer earlier treatment based on testicular growth arrests?
These questions can be only answered when we have better understanding of the pathophysiology of varicocele.