Pathophysiology
The term varicocele specifically refers to dilatation and tortuosity of the pampiniform plexus, which is the network of veins that drain the testicle. This plexus travels along the posterior portion of the testicle with the epididymis and vas deferens, and then into the spermatic cord. This network of veins coalesces into the gonadal, or testicular, vein. The right gonadal vein drains into the inferior vena cava, while the left gonadal vein drains into the left renal vein at right angle to the renal vein, which then drains into the inferior vena cava. one of the main function of the plexus is to lower the temp to the testicles, during vericocele this function is lost, hence the most common complication of untreated vericocele is higher temp to testes resulting in testicular atrophy causing infertility.
The small vessels of the pampiniform plexus normally range from 0.5–1.5 mm in diameter. Dilatation of these vessels greater than 2 mm is called a varicocele.
Recent studies have shown that the detrimental effect of varicocele on the sperm production is progressive and due to reduction in supply of oxygenated blood and nutrient material to the sperm production sites, which persistently reduces the quality and the quantity of the sperms, leading to reduction in their fertility capacity with time.
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