A varicocele is a dilatation of the veins of the plexus papiniformis. This venous plexus is responsible for collecting venous blood from the testicle and taking it to the great blood vessels in the abdominal cavity. Varicocele is the result of a failure of the valves that are located along the course of the venous vessels, which favors the return of blood back. According to its pathological mechanism, this condition does not differ significantly from the cases in which varicose veins are found, for example, on the lower limbs. In the normal male population, it occurs in 10-20%, while in men with infertility its frequency is higher – 19-41%. In approximately 15% of cases, the varicocele is found on the right, and in 85% it involves the left testicle, rarely bilateral involvement. Damage to the testicle resulting from varicocele is due to the retrograde return of blood from the abdomen to the scrotum. This conditions the development of an unfavorable environment for the normal course of spermatogenesis. Under normal conditions, the temperature in the scrotum is lower than the body temperature – about 32 degrees, which is the ideal temperature for adequate sperm production. This temperature is largely maintained by adequate blood drainage from the plexus. A varicocele is responsible for disrupting normal testicular function by several mechanisms. First of all, the lack of normal blood flow and the return of blood back from the veins of the abdominal cavity to the plexus papiniformis make it difficult to cool and lower the temperature in the scrotum. As a result, the temperature there rises and is close to body temperature, which in turn is detrimental to sperm production. Impaired testicular drainage leads to an increase in metabolic waste products and a decrease in nutrition and adequate oxygenation of the testis. All this again hinders the normal production of sperm. Last but not least, impaired testicular drainage as a result of varicocele is responsible for the occurrence of deviations in testosterone concentration and normal androgen production. Varicocele rarely causes complaints, but it can actually be responsible for infertility in up to 40% of cases. The physical examination is especially valuable in guiding or establishing the diagnosis. Usually, the left half of the scrotum is found to be enlarged and the swollen blood vessels can be directly observed or palpated. The testicle on the side with the varicocele may be smaller, but this is not always the case. Sometimes it is necessary to apply the “Valsalva maneuver”, which consists of taking a deep breath and holding it, after which the latter is suddenly exhaled. This favors the filling of the venous plexus and the bulging of the veins. A varicocele can be proven by ultrasound. It is used to visualize the dilated vessels of the plexus papiniformis over 2 mm.Color Doppler ultrasound is the most accurate method for making the diagnosis and for differentiating it from other disease processes in the scrotal cavity. Intraoperative seminal venography followed by immediate varicocele ligation is recommended in adolescent patients to reduce recurrence. Indications for treatment include problems conceiving in couples who have been trying for more than two years and in cases where abnormalities are detected in the spermogram. In addition, all cases in which there is pain or discomfort in the affected testicle or it grows more slowly in adolescents are indications for undertaking surgical treatment. All surgical techniques for the treatment of varicocele aim at interruption of blood flow to the plexus papiniformis. In the high ligation technique, the spermatic vein is discovered intraoperatively and is interrupted by clamping, ligation, and excision of the vessel. Another method involves embolization of the spermatic vein, which is carried out under scopic control after catheterization of the latter. Embolization can be performed with different materials. Most often, embolization coils with a hair coating are used, which facilitates thrombus formation. Operative techniques, although rare, carry the risk of some complications. Hydrocele is the most common among them and occurs in about 12% of cases. The recurrence rate of varicocele varies between 0 and 20% and is largely determined by the treatment technique. Reactive orchitis or orchiepididymitis occurs 2-4 days after testicular surgery and is expressed in local swelling of the latter. It can be prevented by timely application of ice to the operative field. References: Urology – Prof.P. PanchevThe recurrence rate of varicocele varies between 0 and 20% and is largely determined by the treatment technique. Reactive orchitis or orchiepididymitis occurs 2-4 days after testicular surgery and is expressed in local swelling of the latter. It can be prevented by timely application of ice to the operative field. References: Urology – Prof.P. PanchevThe recurrence rate of varicocele varies between 0 and 20% and is largely determined by the treatment technique. Reactive orchitis or orchiepididymitis occurs 2-4 days after testicular surgery and is expressed in local swelling of the latter. It can be prevented by timely application of ice to the operative field. References: Urology – Prof.P. Panchev