V. I. Besprozvanni

Acute scrotal hematoma developing due to spontaneous rupture of the spermatic cord caused by varicocele is a relatively rare complication. Its clinical presentation is similar to testicular torsion, appendix testis torsion and malignant tumor which significantly complicates differential diagnosis. Sudden pain, scrotum enlargement, sometimes cyanosis after intraperitoneal pressure increase or intense physical activity and hematoma on the left should alarm a doctor because they can be signs of vein rupture due to varicocele. Anamnesis of varicocele, character of the injury, color Doppler ultrasound can help in differential diagnosis and to avoid unnecessary orchidectomy. The article presents a review of international literature on a rare complication of varicocele – rupture of the testicular veins.

Multiple evidence suggests that inflammation and oxidative stress negatively affect sperm parameters, spermatogenesis, and testicular and epididymal function, although the etiology of infertility caused by varicocele may be multifactorial. In this regard, the anti-inflammatory effect of various drugs in patients with varicocele is being studied and in the future, it may be possible to develop new treatment methods and conduct an appropriate selection of patients for whom these drugs can help. The article presents a review of the world literature on the influence of the inflammatory process on spermatogenesis in varicocele.

Despite conflicting views on the relationship between varicocele and patho-spermia, numerous studies have proven the negative impact of varicocele on spermato-genesis parameters and ultrastructural characteristics of spermatozoa. Studies conducted in the last decades have somewhat changed the general view on the pathophysiology of pathospermia development in varicocele and revealed the role of interrelated processes: heat stress, oxidative stress (OS), apoptosis, genetic, inflammatory and other factors that contribute to the induction of pathophysiological manifestations.

Scientific studies over the last decades have shown that one of the important mechanisms for the development of pathospermia in varicocele remains oxidative stress, which in interrelationship with other factors (heat stress, metabolite reflux, hypoxia, inflammation) play an important role in negatively affecting spermatogenesis. Pathophysiologic mechanisms contributing to oxidative stress include scrotal hyperthermia, metabolite reflux, testicular hypoxia, and cadmium accumulation. Genetic factors are involved and, in addition, varicocele causes an imbalance of endocrine reproductive hormones, affecting sperm production and leading to male infertility.