ABSTRACT
The male varicocele and its association with infertility have been recognized for many centuries. In De Medicina, written during the first century A.D., Celsus credits the Greeks with the first description of a varicocele and then remarks on veins that “are swollen and twisted over the testicle, which becomes smaller than its fellow, in as much as its nutrition has become defective” (1). Improvements in semen quality after varicocele repair were first suggested by Barwell in 1885, Bennett in 1889, and Macomber and Sanders in 1929 (2-4). In spite of these reports, surgical repair of the varicocele was virtually forgotten until 1952, when the Edinburgh surgeon Selby Tulloch demonstrated the restoration of fertility following excision of bilateral varicoceles in an azoospermic patient (5). Since then, thousands of studies on the diagnosis and surgical correction of varicoceles have appeared in the literature. Unfortunately, this entire body of experimental evidence has been able to neither identify the mechanism of spermatogenesis impairment nor explain why surgical correction improves semen parameters. This chapter will discuss the diagnosis and consequences of varicoceles, review the etiology and hypothesized mechanisms of gonadal effect, and explore treatment options and complications, with a brief consideration of the adolescent varicocele.
