Volume 2 Issue 3
|
2025
|
ISSN
3030-3591
ORIENTAL JOURNAL OF MEDICINE AND NATURAL SCIENCES
“Innovative World” Scientific Research Center
www.innoworld.net
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Abstract:
Varicocele, a common condition in adolescent males, is characterized by the
dilation of the pampiniform plexus veins and is associated with potential
impacts on testicular growth, hormone production, and fertility. The
pathogenesis of varicocele involves both anatomical and hormonal factors,
including venous insufficiency, impaired testicular temperature regulation,
oxidative stress, and inflammatory cytokine activity. Hormonal alterations,
such as reduced testosterone and inhibin B levels, further contribute to
testicular dysfunction. Management strategies range from observation and
monitoring to surgical interventions like microsurgical varicocelectomy,
laparoscopic repair, and percutaneous embolization. Early detection and
appropriate treatment are essential to prevent long-term reproductive
consequences.
Keywords:
varicocele, adolescent males, testicular function, oxidative stress,
varicocelectomy
Introduction
Varicocele, a condition characterized by the dilation of the pampiniform
plexus veins, is a common issue in adolescent males, with a prevalence of
approximately 15% [1] [3]. It is associated with potential impacts on
testicular growth, hormone production, and future fertility. This response
explores the anatomical and hormonal factors involved in the pathogenesis of
varicocele in children and discusses methods for its prevention.
Anatomical Factors in Varicocele Pathogenesis
Venous Insufficiency and Testicular Temperature Regulation
The primary anatomical factor in varicocele development is venous
insufficiency, which leads to impaired blood flow and increased hydrostatic
pressure in the testicular veins [5] [9]. This venous dilation disrupts the
counter-current heat exchange mechanism, resulting in elevated testicular
temperatures. Elevated temperatures can impair spermatogenesis and
testicular function, contributing to the pathogenesis of varicocele [17].
Testicular Atrophy and Asynchronous Growth
THE ROLE OF ANATOMICAL AND HORMONAL
FACTORS IN THE PATHOGENESIS OF VARICOCELE IN
CHILDREN AND METHODS FOR ITS PREVENTION
(LITERATURE REVIEW)
Eminov R.I.,
Yakubov D
.
Y
.
Faculty and Hospital Surgery Department, FMIOPH,
Fergana, Uzbekistan
doniyoryokubov070@gmail.com
Volume 2 Issue 3
|
2025
|
ISSN
3030-3591
ORIENTAL JOURNAL OF MEDICINE AND NATURAL SCIENCES
“Innovative World” Scientific Research Center www.innoworld.net
Page | 27
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Tg: @Anvarbek_PhD
Varicocele is often associated with ipsilateral testicular atrophy, which
may be due to reduced blood flow and oxidative stress [12] [15].
Asynchronous testicular growth, where the affected testis is smaller than the
contralateral one, is a common finding in adolescents with varicocele. This
discrepancy may persist into adulthood if left untreated [3] [16].
Impact on Spermatogenesis
The anatomical abnormalities in varicocele can lead to impaired
spermatogenesis, characterized by reduced sperm count, motility, and
morphology [6] [18]. These changes are thought to result from oxidative
stress, inflammation, and heat-induced damage to the germinal
epithelium [5] [9].
Hormonal Factors in Varicocele Pathogenesis
Testosterone and Gonadotropin Levels
Hormonal alterations, particularly in testosterone levels, have been
observed in adolescents with varicocele. Lower levels of free testosterone
(FT) and total testosterone (TT) are associated with higher grades of
varicocele [1]. These hormonal changes may contribute to impaired testicular
function and spermatogenesis [12].
Inflammatory Cytokines and Oxidative Stress
Varicocele is associated with increased levels of pro-inflammatory
cytokines such as IL-1β, IL-6, and TNFα, which contribute to endothelial
dysfunction and chronic inflammation [5]. These inflammatory processes
exacerbate oxidative stress, further impairing testicular function [9].
Role of Inhibin B and FSH
Inhibin B, a marker of Sertoli cell function, is often reduced in patients
with
varicocele,
indicating
impaired
testicular
growth
and
development [8] [12]. Elevated follicle-stimulating hormone (FSH) levels may
also be observed, reflecting compromised spermatogenesis [1] [3].
Methods for Prevention and Management
Observation and Monitoring
For asymptomatic patients with mild varicocele, observation and
regular monitoring are often recommended. This approach involves serial
ultrasound measurements of testicular volume and semen analysis to assess
for any signs of testicular dysfunction [3] [16].
Surgical Intervention
Surgical intervention is indicated in cases of significant testicular
atrophy, persistent pain, or abnormal semen parameters. Microsurgical
varicocelectomy is the preferred technique due to its high success rate and
low complication profile [4] [9]. This procedure involves the ligation of dilated
veins while preserving the testicular artery and lymphatic vessels.
Minimally Invasive Techniques
Laparoscopic and percutaneous embolization techniques are alternative
approaches for varicocele treatment. These methods are less invasive and
Volume 2 Issue 3
|
2025
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ISSN
3030-3591
ORIENTAL JOURNAL OF MEDICINE AND NATURAL SCIENCES
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may reduce the risk of postoperative complications such as
hydrocele [10] [16].
Hormonal and Medical Therapy
In some cases, medical therapy may be considered to address hormonal
imbalances or inflammation. Anti-inflammatory agents and antioxidants have
been used to mitigate oxidative stress and improve testicular function [6] [9].
Table: Comparison of surgical techniques for varicocele repair
Technique
Description
Advantages
Citation
Microsurgical
Varicocelectomy
Subinguinal approach
with magnification to
ligate dilated veins
High success rate,
minimal complications,
preservation of testicular
artery
[4] [9]
Laparoscopic
Varicocelectomy
Minimally invasive
approach using
laparoscopic
instruments
Reduced postoperative
pain, shorter recovery
time
[10] [16]
Percutaneous
Embolization
Radiological occlusion
of dilated veins
Less invasive, reduced
risk of hydrocele
[10] [16]
Conclusion
Varicocele in children and adolescents is influenced by both anatomical
and hormonal factors, including venous insufficiency, testicular atrophy, and
inflammatory cytokine production. Early intervention, whether through
observation or surgical correction, is critical to preserve testicular function
and future fertility. Further research is needed to establish definitive
guidelines for the management of varicocele in pediatric populations.
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