• S. Nilsson
Part of the Clinical Practice in Urology book series (PRACTICE UROLOG)


This statement concerning varicocele was made by Amelius Cornelius Cellsus who lived from 42 b.c. to 37 a.d. and implies that the varicocele can give rise to atrophy of the testicle. The association between varicocele and subfertility became a matter of interest when Wilhelm (1937) and Hammen (1944) found that varicocele could influence spermatogenesis and when Tulloch (1952) reported the restoration of fertility to an azoospermic man. We still do not know the mechanisms by which a varicocele affects testicular function nor how often this occurs in the male population. Several theories, including increased scrotal temperature, retrograde flow of substances from the adrenal gland down the spermatic vein, and hypoxia of the germinal epithelium, are discussed in the literature. It is also a common belief that varicocele is associated with specific abnormalities of spermatozoal morphology. A marked improvement in semen quality and high rates of pregnancy after testicular vein ligation in many studies have been regarded as evidence in support of the role of varicocele in infertility. Recently, however, the efficacy of varicocelectomy in subfertile patients has been questioned.


Sperm Motility Sperm Count Male Infertility Semen Quality Spermatic Vein 
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  1. Agger P (1971a) Plasma Cortisol in the left spermatic vein in patients with varicocele. Fertil Steril 22: 270–274PubMedGoogle Scholar
  2. Agger P (1971b) Scrotal and testicular temperature: its relation to sperm count before and after operation for varicocele. Fertil Steril 22: 286–297PubMedGoogle Scholar
  3. Agger P, Johnsen SG (1978) Quantitative evaluation of testicular biopsies in varicocele. Fertil Steril 29: 52–57PubMedGoogle Scholar
  4. Ahlberg NE, Bartley О, Chidekel N, Fritjofsson Å (1968) Phlebography in varicocele scroti. Acta Radiol [Diagn] 4: 517–528Google Scholar
  5. Brown JS, Dubin L, Becker M, Hotchkiss RS (1967) Venographv in the subfertile man with varicocele. J Urol 98: 388–392PubMedGoogle Scholar
  6. Caldamone AA, Al-Jaburi A, Cockett ATK (1980) Varicocele: elevated serotonin and infertility. J Urol 123: 683–685PubMedGoogle Scholar
  7. Charny CW (1962) Effect of varicocele on fertility. Results of varicocelectomy. Fertil Steril 13: 47–56PubMedGoogle Scholar
  8. Clarke BG (1966) Incidence of varicocele in normal men among men of different ages. JAMA 198: 1121–1122PubMedCrossRefGoogle Scholar
  9. Cohen MS (1979) The effects of prostataglandins in subfertile men with varicoceles. Presentation, Sixty-fourth Annual Meeting, American Urological Association, New York, May 13–17Google Scholar
  10. Comhaire F, Vermeulen A (1974) Varicocele sterility: Cortisol and catecholamines. Fertil Steril 25: 88–95PubMedGoogle Scholar
  11. Comhaire F, Monteyne R, Kunnen M (1976) The value of scrotal thermography as compared with selective retrograde venography of the internal spermatic vein for the diagnosis of ‘subclinical’ varicocele. Fertil Steril 27: 694–698PubMedGoogle Scholar
  12. Desai SB, Cohen MS, Orkin LA (1978) Left spermatic vein prostataglandin F2α levels in subfertile men with varicocele. Infertility 1: 59–62Google Scholar
  13. Dubin L, Hotchkiss RS (1969) Testis biopsy in subfertile men with varicocele. Fertil Steril 20: 50–57Google Scholar
  14. Dubin L. Amelar RD (1975) Varicocelectomy as therapy in male infertility: a study of 504 cases. Fertil Steril 26: 217–220PubMedGoogle Scholar
  15. Dubin L, Amelar RD (1977a) The varicocele and infertility. In: Amelar RD, Dubin L, Walsh PC (eds) Male infertility. W В Saunders, London, pp 57–68Google Scholar
  16. Dubin L, Amelar RD (1977B) Varicoceletomy: 986 cases in a twelve-year study. Urol 10: 446–449Google Scholar
  17. Etriby A, Girgis SM, Hefnaway H, Ibrahim AA (1967) Testicular changes in subfertile males with varicocele. Fertil Steril 18: 666–671PubMedGoogle Scholar
  18. Etriby A, Ibrahim AA, Mahmoud KZ, Elhaggar S (1975) Subfertility and varicocele. I. Venogram demonstration of anastomosis sites in subfertile men. Fertil Steril 26: 1013–1017PubMedGoogle Scholar
  19. Fritjofosson Å, Åhrén С (1967) Studies on varicocele and subfertility. Scand J Urol Nephrol 1: 55–62CrossRefGoogle Scholar
  20. Gasser G, Strassi R, Pokieser H (1973) Thermogram des Hodens und Spermiogramm. Andrologia 5: 127–131CrossRefGoogle Scholar
  21. Greenberg SH (1977) Varicocele and male fertility. Fertil Steril 28: 699–706PubMedGoogle Scholar
  22. Greenberg SH, Lipshultz LI, Wein AJ (1979) A preliminary report of ‘subclinical varicocele’: diagnosis by Doppler ultrasonic stethoscope. Examination and results of surgical therapy. J Reprod Med 22: 77–81PubMedGoogle Scholar
  23. Hammen R (1944) Studies on impaired fertility in man with special reference to the male. Acta Obstet Gynecol Scand (Suppl 3) 24Google Scholar
  24. Hanley HG, Harrison RG (1962) The nature and surgical treatment of varicocele. Brit J Sug 50: 64–67CrossRefGoogle Scholar
  25. Hanley HG (1966) The results of surgical treatment of varicocele. Proc Roy Soc Med 59: 767–769PubMedGoogle Scholar
  26. Hill JT, Green A (1977) Varicocele: a review of radiological and anatomical features in relation to surgical treatment. Br J Surg 64: 747–752PubMedCrossRefGoogle Scholar
  27. Hirsch AV, Kellett MJ, Robertson G, Pryor JP (1980a) Doppler flow studies, venography and thermography in the evaluation of varicoceles of fertile and subfertile men. Br J Urol 52: 560–565CrossRefGoogle Scholar
  28. Hirsch AV, Cameron KM, Tyler JP, Simpson J, Pryor JP (1980b) The Doppler assessment of varicoceles and internal spermatic vein reflux in infertile men. Br J Urol 52: 50–56CrossRefGoogle Scholar
  29. Hirsch AV, Pryor JP (1981) Are there different types of varicocele? In: Proceedings of the 2nd International Congress of Andrology, Tel Aviv, p 75Google Scholar
  30. Ivanissevich О (1960) Left varicocele due to reflux: Experience with 4470 operative cases in forty-two years. J Int Coll Surg 34: 742–755PubMedGoogle Scholar
  31. Johnsen SG, Agger P (1978) Quantitative evaluation of testicular biopsies before and after operation for varicocele. Fertil Steril 29: 58–62PubMedGoogle Scholar
  32. Jönsson G, Olsson Am, Luttrop W, Cekan Z, Purvis K, Dicsfalusy E (1975) Treatment of prostatic carcinoma with various types of estrogen derivatives. Vitam Horm 33: 351–376PubMedCrossRefGoogle Scholar
  33. Koromano M, Kahanpää K, Svinhufvud U, Tähti E (1970) Thermography of varicocele. Fertil Steril 21: 558–564Google Scholar
  34. Koumans J, Steeno О, Heyns W, Michielsen JP (1969) Dehydroepiandrosterone sulphate, androsterone sulphate and corticoids in spermatic vein blood of patients with left varicocele. Andrologia 1: 87–89CrossRefGoogle Scholar
  35. Lewis RW, Harrison RM (1979) Contact scrotal thermography: Applications to problems of infertility. J Urol 122: 40–42PubMedGoogle Scholar
  36. Lindholmer C, Thulin L, Eliasson R (1973) Concentrations of Cortisol and renin in the internal spermatic vein of men with varicocele. Andrologia 5: 21–22CrossRefGoogle Scholar
  37. MacLeod J (1951) Effect of chickenpox and pneumonia on semen quality. Fertil Steril 2: 523–533PubMedGoogle Scholar
  38. MacLeod J (1962a) A possible factor in the etiology of human male infertility Fertil Steril 13: 29–33Google Scholar
  39. MacLeod J (1962b) A testicular response during and following a severe allergic reaction. Fertil Steril 13: 531–543Google Scholar
  40. MacLeod J (1964) Human seminal cytology as a sensitive indicator of the germinal epithelium. Int J Fertil 9: 281–295PubMedGoogle Scholar
  41. MacLeod J (1965) Seminal cytology in the presence of varicocele. Fertil Steril 16: 735–757PubMedGoogle Scholar
  42. MacLeod J (1969) Further observations on the role of varicocele in human male infertility. Fertil Steril 20: 545–563PubMedGoogle Scholar
  43. Nilsson S, Edvinsson A, Nilsson В (1979) Improvement of semen and pregnancy rate after ligation and division of the internal spermatic vein. Fact or fiction? Br J Urol 51: 591–596PubMedCrossRefGoogle Scholar
  44. Palomo A (1949) Radical cure of varicocele by a new technique: preliminary report. J Urol 61: 604–607PubMedGoogle Scholar
  45. Rodriguez-Rigau LJ, Smith KD, Steinberger E (1978a) Relationship of varicocele to sperm output and fertility of male partners in infertile couples. J Urol 120: 691–694PubMedGoogle Scholar
  46. Rodriguez-Rigau LJ, Weiss DB, Smith KD, Steinberger E (1978b) Suggestion of abnormal testicular steroidogenesis in Oligospermic men. Acta Endocrinol (Kbh) 87: 400–412Google Scholar
  47. Sayfan J, Adam YG, Soffer Y (1980) A new entity in varicocele subfertility: the ‘cremasteric reflux’ Fertil Steril 33: 88–90Google Scholar
  48. Segal S, Sadrovsky E, Palti Z (1975) Serotonin and 5-hydroxyindole acetic acid in fertile and subfertile men. Fertil Steril 26: 314–316PubMedGoogle Scholar
  49. Stephenson JD, O’Shaughnessy EJ (1968) Hypospermia and its relationship to varicocele and intrascrotal temperature. Fertil Steril 19: 110–117PubMedGoogle Scholar
  50. Tessler AN, Krahn HP (1966) Varicocele and testicular temperature. Fertil Steril 17: 201–203PubMedGoogle Scholar
  51. Torre de la В, Norén S, Hedman M, Discfalusy E (1978) Studies on the relationship between sperm count and steroid levels in the spermatic and cubital veins of patients with varicocele. Int J Androl 1: 297–307CrossRefGoogle Scholar
  52. Tulloch WS (1952) A consideration of sterility factors in the light of subsequent pregnancies. II. Subfertility in the male. Trans Edinb Obstet Soc 104: 29–34Google Scholar
  53. Uehling DT (1968) Fertility in men with varicocele. Int J Fertil 13: 58–60PubMedGoogle Scholar
  54. Wallijn E, Desmet R (1978) Hydrocele: A frequently overlooked complication after high ligation of spermatic vein for varicocele. Int J Androl 1: 411–415CrossRefGoogle Scholar
  55. Weiss DB, Rodriguez-Rigau LJ, Smith KD, Steinberger (1978a) Leydig cell function in Oligospermic men with varicocele. J Urol 120: 427–430PubMedGoogle Scholar
  56. Weiss DB, Rodriguez-Rigau LJ. Smith KD, Chowdhury A, Steinberger E (1978b) Quantitation of Leydig cells in testicular biopsies of Oligospermic men with varicocele. Fertil Steril 30: 305–312Google Scholar
  57. Wihelm SF (1937) Sterility in males. Oxford University Press, LondonGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1983

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  • S. Nilsson

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