Varicocele is considered a predominantly unilateral left-sided disease. However, since male fertility is preserved with only one healthy testis, infertility perforce represents bilateral testicular dysfunction. It was hypothesized that: (i) right varicocele cannot be diagnosed by palpation and therefore has not been treated in the past by the traditional treatment, and (ii) right varicocele causes impaired oxygen supply in the right testicular microcirculation, leading to germ cell degeneration. This study performed venographies of both right and left internal spermatic veins during the treatment of 840 infertile men with varicocele and analysed the results using tools of fluid mechanics. Histopathology of the right testis revealed stagnation of blood flow and degenerative changes attributed to lack of adequate oxygenation in all testicular cell types. Right varicocele was found in the vast majority of the patients. We found that due to the destruction of one-way valves, pathologic hydrostatic pressure is produced in the testicular venous microcirculatory system about five times higher than normal, exceeding arteriolar pressure. The pressure gradient between the arterioles and venules in the testicular tissue is therefore reversed, leading to persistent hypoxia. Right varicocele, although undetected, is prevalent in infertile men with varicocele, hence only bilateral occlusion of the internal spermatic veins, including the associated bypasses, eliminating the pathologic hydrostatic pressure will lead to resumption of arterial blood flow in the testicular microcirculation.

译文

:精索静脉曲张被认为是主要的单侧左侧疾病。但是,由于只有一个健康的睾丸才能维持男性的生育能力,因此不育症的强迫表现为双侧睾丸功能障碍。假设:(i)右精索静脉曲张不能通过触诊诊断,因此过去没有通过传统疗法进行治疗;(ii)右精索静脉曲张导致右睾丸微循环中的氧气供应受损,从而导致生殖细胞变性。这项研究在对840名不育男性精索静脉曲张的治疗过程中进行了左右精索静脉的静脉造影,并使用流体力学工具对结果进行了分析。右睾丸的组织病理学显示血流停滞和变性变化归因于所有睾丸细胞类型缺乏足够的氧合。在绝大多数患者中发现了右精索静脉曲张。我们发现,由于单向阀的破坏,睾丸静脉微循环系统中产生的病理性静水压力比正常高约五倍,超过了小动脉压力。因此,睾丸组织中小动脉和小静脉之间的压力梯度会反向,从而导致持续的缺氧。右精索静脉曲张虽然未被发现,但在精索静脉曲张的不育男性中很普遍,因此,只有双侧内精子静脉闭塞,包括相关的旁路,消除病理性静水压会导致睾丸微循环中动脉血流的恢复。

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