Varicocele and male infertility: Historical, anatomical and urological perspectives – a mini review

Varicocele is defined as an abnormal dilatation of the pampiniform plexus of the spermatic cord. This is seen in 10 to 20% of general population and is one of the most common correctable causes of male infertility. The history of varicocele dates back to the era of Ancient Greeks to about 600 BC, who had sculptured varicocele in their statues as a tortuous bag of wormsin the scrotum. It was Ambrose Pare who gave a poetic description to the pooling of blood in the spermatic cords and subsequently Curling coined the term Varicocele The intricacy of the venous drainage of the scrotum and its contents and the criss crossing of the veins makes the thermo-regulatory mechanism regulating spermatogenesis, even more complex. The Cremaster and Dartos greatly aid in facilitating the thermo-regulatory mechanism of scrotal wall, which forms the anatomical basis of oligospermia in patients with varicocele. Apart from a visible change in seminal parameters, the benefits of varicocelectomy have extended on to an improvement in serum testosterone and enhancement of erectile and ejaculatory functions. With a greater knowledge of the pathophysiology of varicocele and with better understanding of the roles of gene polymorphisms and reactive oxygen species, the indications for varicocelectomy gain more support and evidence. A sound anatomical knowledge and an in-depth understanding of the events that take place at molecular level might shift the treatment focus in future from varicocelectomy to molecular targeted therapies.