ABSTRACT
Varicocele is likely a consequence of bipedal walking and upright motion, which changed forever the mechanics of deoxygenated blood flow from the scrotum to the heart. Clinically significant varicocele results from continuous or spontaneous rather than Valsalva-induced spermatic venous reflux. Coupled with rapid peripubertal linear growth in adolescence, anti-gravitational forces can overcome venous valvular competence, resulting in a varicocele. Importantly, varicocele contributes to sub-fertility, and is more common in men seeking infertility treatment. The authors have previously shown that correction of varicocele in boys with asymmetrical testes can restore sperm parameters to normal in about 40%, and improve the remainder. Any persistent varicoceles were successfully managed with repeat sclerotherapy, and there were no instances of postoperative testicular atrophy. One postoperative hydrocele was managed surgically with a Jaboulay procedure. There is some confusion around the nomenclature of “varicocelectomy:”. The peritoneum is divided to expose the vascular bundle proximal to the deep ring.
