Varicocele: historical background, anatomical features, and prerequisites for development

Authors

DOI:

https://doi.org/10.14739/2310-1210.2025.4.327544

Keywords:

history of varicocele investigation, history of medicine, anatomical features of the testicular venous system, surgery, children

Abstract

Varicocele, an abnormal enlargement of the pampiniform venous plexus in the scrotum. This paper provides an overview of important information on the historical aspects, anatomical structure of the testicular vascular system, and hemodynamic prerequisites for the development of varicocele.

The aim of this study is to analyze scientific papers focused on the anatomical and etiopathogenetic features of varicocele.

Materials and methods. This paper is a literature review (PubMed, Scopus, Embase) describing the history of varicocele investigation, anatomical features of the testicular venous system, and the hemodynamic prerequisites of the pathology.

Results. In elective pediatric surgery, varicocele is one of the most common pathologies among boys over the age of 10, with a prevalence of 14–20 %. However, the pathophysiology of varicocele and the optimal treatment approach remain subjects of ongoing debate. Nonetheless, all research on the origins and treatment of varicocele contributes to a growing knowledge base. The authors, relying on scientific studies, anatomical knowledge, and surgical experience, describe the historical background of the disease, the anatomical prerequisites, and the causes of varicocele development in children.

The paper highlights the anatomical features of testicular blood supply and the hemodynamic conditions for the development of varicocele, which partially elucidate the disease’s etiopathogenesis and serve as a step toward optimizing the choice of surgical treatment method.

Conclusions. Varicocele as a pathology has been known since ancient times, and approaches to its treatment have evolved over the centuries. Disruptions in the embryogenesis of the venous system, venous valve insufficiency, and arteriovenous conflicts are key factors in the development of varicocele. Understanding these anatomical features is crucial for selecting the appropriate surgical approach and improving treatment effectiveness.

Author Biographies

O. B. Bodnar, Bukovinian State Medical University, Chernivtsi

MD, PhD, DSc, Professor, Head of the Department of Pediatric Surgery, Otolaryngology and Ophthalmology

A. P. Stetskevych, Bukovinian State Medical University, Chernivtsi

MD, PhD-student of the Department of Pediatric Surgery, Otolaryngology and Ophthalmology; pediatric surgeon, Korosten Central City Hospital

Ye. O. Ferenchuk, Bukovinian State Medical University, Chernivtsi

PhD, Associate Professor of the Department of Bioorganic and Biological Chemistry and Clinical Biochemistry

A. O. Bodnar, Bukovinian State Medical University, Chernivtsi

student

References

  1. Gasimov K, Dogan HS. Varicocele in adolescents and children. Hell Urol. 2025;37:34-9. doi: https://doi.org/10.23736/S2241-9136.24.00061-6
  2. Dihtiar VA, Vernihora DH. [Varicocele in children and adolescents. History and current view and state of problem (literature review)]. Paediatric Surgery. 2021;1(70):68-73. Ukrainian. doi: https://doi.org/10.15574/PS.2021.70.68
  3. Marmar JL. The Evolution and Refinement of Varicocele Treatment: A Historical Perspective. In: Esteves S, Cho CL, Majzoub A, Agarwal A, editors. Varicocele and Male Infertility. Cham: Springer International Publishing; 2019. p. 3-16. doi: https://doi.org/10.1007/978-3-319-79102-9_1
  4. Bloom DA, Milen MT, Heininger JC. Claudius Galen: from a 20th century genitourinary perspective. J Urol. 1999;161(1):12-9. doi: https://doi.org/10.1016/s0022-5347(01)62046-9
  5. Pata F, Linardi C, Brady RR, Pellino G and D’Ambrosio G. Bruno da Longobucco (da Longoburgo): The first academic surgeon in the Middle Ages. Front. Surg. 2022;9:1025987. doi: https://doi.org/10.3389/fsurg.2022.1025987. Erratum in: Front Surg. 2023;10:1153127. doi: https://doi.org/10.3389/fsurg.2023.1153127
  6. Nöske HD, Weidner W. Varicocele - a historical perspective. World J Urol. 1999;17(3):151-7. doi: https://doi.org/10.1007/s003450050123
  7. Marte A. The history of varicocele: from antiquity to the modern ERA. Int Braz J Urol. 2018;44(3):563-76. doi: https://doi.org/10.1590/S1677-5538.IBJU.2017.0386
  8. Androutsos G, Karamanou M, Pappa KI, Poulakou-Rebelakou E. The specialist in testicular diseases, Thomas Blizzard Curling (1811-1888), and his method of treatment of varicocele, among other methods of treatment in the 19th century. Archives of andrology. 2011;21(2):90-8. doi: https://doi.org/10.1007/s12610-011-0124-5
  9. Andrade-Rocha FT. On the Origins of the Semen Analysis: A Close Relationship with the History of the Reproductive Medicine. J Hum Reprod Sci. 2017;10(4):242-55. doi: https://doi.org/10.4103/jhrs.JHRS_97_17
  10. González R. Proposal for describing procedures to correct varicocele. A new terminology. Front Pediatr. 2014;2:47. doi: https://doi.org/10.3389/fped.2014.00047
  11. Thomas AJ. Foreword: varicocele--unraveling the enigma. Asian J Androl. 2016;18(2):159-60. doi: https://doi.org/10.4103/1008-682X.172643
  12. Ivanissevich O. Left varicocele due to reflux; experience with 4,470 operative cases in forty-two years. J Int Coll Surg. 1960;34:742-55.
  13. Jensen CFS, Østergren P, Dupree JM, Ohl DA, Sønksen J, Fode M. Varicocele and male infertility. Nat Rev Urol. 2017;14(9):523-33. doi: https://doi.org/10.1038/nrurol.2017.98
  14. Tiralongo F, Distefano G, Palermo M, Granata A, Giurazza F, Vacirca F, et al. Liquid and Solid Embolic Agents in Gonadal Veins. J Clin Med. 2021;10(8):1596. doi: https://doi.org/10.3390/jcm10081596
  15. Marmar JL, DeBenedictis TJ, Praiss D. The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertil Steril. 1985;43(4):583-8. doi: https://doi.org/10.1016/s0015-0282(16)48501-8
  16. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 1992;148(6):1808-11. doi: https://doi.org/10.1016/s0022-5347(17)37035-0
  17. Aaberg RA, Vancaillie TG, Schuessler WW. Laparoscopic varicocele ligation: a new technique. Fertil Steril. 1991;56(4):776-7. doi: https://doi.org/10.1016/s0015-0282(16)54615-9
  18. Hagood PG, Mehan DJ, Worischeck JH, Andrus CH, Parra RO. Laparoscopic varicocelectomy: preliminary report of a new technique. J Urol. 1992;147(1):73-6. doi: https://doi.org/10.1016/s0022-5347(17)37137-9
  19. Kaouk JH, Palmer JS. Single-port laparoscopic surgery: initial experience in children for varicocelectomy. BJU Int. 2008;102(1):97-9. doi: https://doi.org/10.1111/j.1464-410X.2008.07584.x
  20. Marte A, Pintozzi L, Cavaiuolo S, Parmeggiani P. Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques. Afr J Paediatr Surg. 2014;11(3):201-5. doi: https://doi.org/10.4103/0189-6725.137325
  21. Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, et al. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc. 2005;19(1):117-9. doi: https://doi.org/10.1007/s00464-004-9004-9
  22. Marmar JL. The evolution and refinements of varicocele surgery. Asian J Androl. 2016;18(2):171-8. doi: https://doi.org/10.4103/1008-682X.170866
  23. Finelli R, Leisegang K, Kandil H, Agarwal A. Oxidative stress: a comprehensive review of biochemical, molecular, and genetic aspects in the pathogenesis and management of varicocele. World J Mens Health. 2022;40(1):87-103. doi: https://doi.org/10.5534/wjmh.210153
  24. Jeremias JT, Belardin LB, Okada FK, Antoniassi MP, Fraietta R, Bertolla RP, et al. Oxidative origin of sperm DNA fragmentation in the adult varicocele. Int Braz J Urol. 2021;47(2):275-83. doi: https://doi.org/10.1590/S1677-5538
  25. You K, Chen BB, Wang P, Bu RG, Xu XW. Intense venous reflux, quantified by a new software to analyze presurgical ultrasound, is associated with unfavorable outcomes of microsurgical varicocelectomy. Asian J Androl. 2023;25(1):119-25. doi: https://doi.org/10.4103/aja202248
  26. Zou P, Fan G, Li Z, Tao Y, Jia C, Liang H, et al. A new approach for hemodynamics of varicoceles: blood flow patterns based on contrast-enhanced ultrasound. Basic Clin. Androl. 2025;35(1):4 doi: https://doi.org/10.1186/s12610-024-00249-8
  27. Salem HK, Mostafa T. Preserved testicular artery at varicocele repair. Andrologia. 2009;41(4):241-5. doi: https://doi.org/10.1111/j.1439-0272.2009.00926.x
  28. Pasiechnikov SP, Vozianov SO, Lesovoy VM, Kostyev FI, Lyulko OO, Sarychev LP, et al. Urology. Vinnytsia, Ukraine: Nova Knyha; 2019.
  29. Tian RH, Zhao LY, Chen HX, Yang C, Li P, Huang YH, et al. Microsurgical subinguinal varicocelectomy with spermatic cord double traction and vein stripping. Asian J Androl. 2020;22(2):208-12. doi: https://doi.org/10.4103/aja.aja_118_19
  30. Shafik A, Moftah A, Olfat S, Mohi-el-din M, El-Sayed A. Testicular veins: anatomy and role in varicocelogenesis and other pathologic conditions. Urology. 1990;35(2):175-82. doi: https://doi.org/10.1016/0090-4295(90)80071-t
  31. Fuse H, Okumura A, Sakamoto M, Ohta S, Katayama T. Laparoscopic varicocele ligation. Int Urol Nephrol. 1996;28(1):91-7. doi: https://doi.org/10.1007/bf02550144
  32. Lechter A, Lopez G, Martinez C, Camacho J. Anatomy of the gonadal veins: a reappraisal. Surgery. 1991;109(6):735-9.
  33. Forte F, Latini M, Foti N, Sorrenti S, De Antoni E, Virgili G, et al. Bahren types III and IVa testicular vein anomalies as a reason for failure in left idiopathic varicocele retrograde sclerotherapy. Ontogenic discussion and clinical implications. Surg Radiol Anat. 2001;23(6):427-31. doi: https://doi.org/10.1007/s00276-001-0427-x
  34. Itoh M, Moriyama H, Tokunaga Y, Miyamoto K, Nagata W, Satriotomo I, et al. Embryological consideration of drainage of the left testicular vein into the ipsilateral renal vein: analysis of cases of a double inferior vena cava. Int J Androl. 2001;24(3):142-52. doi: https://doi.org/10.1046/j.1365-2605.2001.00286.x
  35. Wu S, Zuo D, Cai D, Chen Q, Li Y. Curated findings and implications in duplex ultrasound interrogation of the scrotum or varicoceles. Sci Rep. 2020;10(1):22028. doi: https://doi.org/10.1038/s41598-020-78619-1
  36. Asala S, Chaudhary SC, Masumbuko-Kahamba N, Bidmos M. Anatomical variations in the human testicular blood vessels. Ann Anat. 2001;183(6):545-49. doi: https://doi.org/10.1016/S0940-9602(01)80064-9
  37. Mirilas P, Mentessidou А. Microsurgical subinguinal varicocelectomy in children, adolescents, and adults: surgical anatomy and anatomically justified technique. Journal of Andrology. 2012;33(3):338-49. doi: https://doi.org/10.2164/jandrol.111.013052
  38. Kebing Y, Chenglu W, Xiaobo X, Tiliwalidi A, Liao Z. Effects of Systolic Blood Pressure Elevation on Internal Sperm Artery Identification During Microsurgical Subinguinal Varicocelectomy. Am J Mens Health. 2024;18(4). doi: https://doi.org/10.1177/15579883241265071
  39. Coolsaet BL. The varicocele syndrome: venography determining the optimal level for surgical management. J Urol. 1980;124(6):833-9. doi: https://doi.org/10.1016/s0022-5347(17)55688-8
  40. Vianello FA, Mazzoni MB, Peeters GG, Fossali EF, Camozzi P, Bianchetti MG, et al. Micro- and macroscopic hematuria caused by renal vein entrapment: systematic review of the literature. Pediatr Nephrol. 2016;31(2):175-84. doi: https://doi.org/10.1007/s00467-015-3045-2
  41. Belay RE, Huang GO, Shen JK, Ko EY. Diagnosis of clinical and subclinical varicocele: how has it evolved? Asian J Androl. 2016;18(2):182-5. doi: https://doi.org/10.4103/1008-682X.169991
  42. EAU Guidelines. Edn. presented at the EAU Annual Congress Paris 2024. ISBN 978-94-92671-23-3
  43. Bertolotto M, Cantisani V, Drudi FM, Lotti F. Varicocoele. Classification and pitfalls. Andrology. 2021;9:1322-30. doi: https://doi.org/10.1111/andr.13053
  44. Raheem OA. Surgical management of adolescent varicocele: Systematic review of the world literature. Urol Ann. 2013;5(3):133-9. doi: https://doi.org/10.4103/0974-7796.115728
  45. Kobza II, Nesterenko IR, Nesterenko VL. [Diagnostic and therapeutic tactics for aortic-mesenteric forceps]. Galician medical journal. 2018;25(3):58-62. Ukrainian. doi: https://doi.org/10.21802/gmj.2018.3.12
  46. Maharaj D, Mohammed SR, Caesar K, Dindyal S. Nutcracker syndrome: a case-based review. Ann R Coll Surg Engl. 2024;106(5):396-400. doi: https://doi.org/10.1308/rcsann.2023.0090
  47. Wang Y, Zhou Y, Liu CY. A rare case of nutcracker phenomenon with nephrotic syndrome. Int Urol Nephrol. 2016;48(4):631-2. doi: https://doi.org/10.1007/s11255-015-1158-y
  48. Mosavari H, Sarafi M, Hosseininasab A, Narimani N, Khaleghian M, Saberi A. Renal nutcracker syndrome presenting with varicocele: A case series. Int J Surg Case Rep. 2024;124:110393. doi: https://doi.org/10.1016/j.ijscr.2024.110393
  49. Yoon T, Kim SH, Kang E, Kim S. Nutcracker Phenomenon and Syndrome May Be More Prevalent Than Previously Thought. Korean J Radiol. 2022;23(11):1112-4. doi: https://doi.org/10.3348/kjr.2022.0617
  50. Vahis YH, Vlasenko DA. [Hemodynamics of varicocele: from pathogenesis to treatment]. Therapeutics. 2022;3(2-3):80-7. Ukrainian. doi: https://doi.org/10.31793/2709-7404.2022.3-2-3.80
  51. May R, Thurner J. The cause of the predominately sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8(5):419-27. doi: https://doi.org/10.1177/000331975700800505
  52. Nykonenko AO, Havrylenko BS. [Pelvic congestion syndrome: historical aspects and a modern view on the problem (a literature review)]. Zaporozhye medical journal. 2021;23(5):723-9. Ukrainian. doi: https://doi.org/10.14739/2310-1210.2021.5.224621
  53. Williams ZF, Dillavou ED. A systematic review of venous stents for iliac and venacaval occlusive disease. J Vasc Surg Venous Lymphat Disord. 2020;8(1):145-53. doi: https://doi.org/10.1016/j.jvsv.2019.08.015
  54. Akinleye A, Kwaah P, Poku-Adusei J, Kavandi H, Norman K. May-Thurner syndrome: A case of extensive unprovoked left lower extremity deep vein thrombosis (DVT). Radiol Case Rep. 2023;27;19(2):680-3. doi: https://doi.org/10.1016/j.radcr.2023.11.027
  55. Dwivedi A, Singh SN, Sharma A, Sharma R, Mishra T. A Systematic Review of Radiological Diagnosis and Management of May-Thurner Syndrome. J Pharm Bioallied Sci. 2024;16(Suppl 2):S1012-S1016. doi: https://doi.org/10.4103/jpbs.jpbs_1135_23
  56. Cheng L, Zhao H, Zhang FX. Iliac Vein Compression Syndrome in an Asymptomatic Patient Population: A Prospective Study. Chin Med J. 2017;130(11):1269-75. doi: https://doi.org/10.4103/0366-6999.206341

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2025-08-31

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1.
Bodnar OB, Stetskevych AP, Ferenchuk YO, Bodnar AO. Varicocele: historical background, anatomical features, and prerequisites for development. Zaporozhye Medical Journal [Internet]. 2025Aug.31 [cited 2026May16];27(4):325-32. Available from: https://zmj.zsmu.edu.ua/article/view/327544

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Vol. 27 No. 4 (2025)

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Copyright (c) 2025 O. B. Bodnar, A. P. Stetskevych, Ye. O. Ferenchuk, A. O. Bodnar

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