Clinical aspects of vascular anatomy in patients with varicocele (lecture)

Problem of varicocele is characterized by the presence of conflicting data and the lack of a unified views at the definition, etiology, pathogenesis, diagnosis, classification and treatment of this disease. In the presented work we analyze the known and little-known data about the etiology, pathogenesis and diagnosis of varicocele. We express a new term "venous anastomotic site of the testis and epididymis", defining the anatomical relationship between the testicular vein, vein of cremaster and a vein of the vas deferens. We define also the "scroto-pelvical venous anastomoses" in varicocele: 1) “Reno-pelvical” (between the left renal vein via the left testicular vein and venous anastomotic node of the testis and the epididymis through the vas deferens vein into the prostate), 2) "ilio-pelvical" (between the left common iliac vein via a cremaster vein and venous anastomotic site of the testis and the epididymis through the vein of the vas deferens into the prostate). The classification of varicocele, in terms of the presence or absence of arteriovenous conflicts, is presented. We describe the pathogenesis of the problems associated with varicocele due to arterio-venous conflicts: pathology of the scrotum organs, alterations in the left kidney and the left adrenal gland, pathology of the prostate and pelvic organs. We discuss two independent scenarios for the development of varicocele complications in arteriovenous conflicts: 1) hypotrophy of the testis, pathospermia and hypogonadism; 2) pelvic symptoms due to chronic venous plethora (prostatopathy, pain, dysuria, disorders of the copulative function, hemorrhoids). We show that the standards of management of patients with varicocele and indications for surgical treatment of this disease warrant further study and revision.