[Idiopathic left-sided varicocele. An ontogenetic abnormality?]

Area of Science:

• Urology
• Vascular Surgery
• Developmental Biology

Background:

• Varicocele, particularly left-sided idiopathic varicocele, is a common condition affecting male fertility.
• The role of spermatic vein valves and venous anatomy in varicocele etiology is not fully understood.
• Phlebography is a key diagnostic tool for evaluating venous abnormalities.

Purpose of the Study:

• To investigate the anatomical variations of the left spermatic vein in patients undergoing phlebography for varicocele treatment.
• To explore the relationship between the presence or absence of spermatic vein valves and the occurrence of left-sided varicoceles.
• To discuss the significance of nutcracker phenomena in the context of varicocele pathophysiology.

Main Methods:

• Phlebographic examinations were performed on 659 patients undergoing sclerotherapy for varicoceles.
• Detailed analysis of the left spermatic vein, focusing on valve presence, insertion points, and collateral flow.
• Evaluation of anatomical variations, including nutcracker phenomena (I and II).

Main Results:

• In 484 out of 659 patients (73.4%), no valves were demonstrated in the left spermatic vein.
• 172 patients (25.9%) presented with sufficient valves or absent spermatic vein insertions, exhibiting retrograde flow through collaterals (persistent intercardinal anastomoses).
• The study highlights the prevalence of venous anomalies in patients with left-sided varicoceles.

Conclusions:

• Ontogenetic (developmental) disorders of the secondary abdominal venous system are implicated as the primary cause of idiopathic left-sided varicocele.
• The absence of left spermatic vein valves is a significant finding in a majority of varicocele patients.
• Anatomical variations, including persistent intercardinal anastomoses and nutcracker phenomena, contribute to varicocele development.