Nielsen Matthew E, Zderic Stephen, Freedland Stephen J, Jarow Jonathan P
Department of Urology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Urology. 2006 Aug;68(2):392-6. doi: 10.1016/j.urology.2006.02.005.
Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men presenting with infertility, yet controversy exists regarding their etiology. Anecdotal experience suggests that varicoceles are more prevalent in lean men, supporting the "nutcracker" effect of the superior mesenteric artery compressing the left renal vein over the aorta. We examined this hypothesis in a large adult population.
A total of 2106 men were evaluated for infertility or erectile dysfunction from 1990 to 1996. The men were examined for the presence and severity of a varicocele. The association between age, height, body mass index, year of evaluation, and reason for consultation and the presence and severity of a varicocele was examined using logistic regression analysis.
The mean age was 47 years (range 18 to 85), and the median body mass index was 26.4 kg/m2 (range 15.4 to 53.3). A varicocele was present in 398 men (18.9%). Stratified by grade, 59 (14.8%) were grade III, 155 (38.9%) were grade II, and 184 (46.2%) were grade I. The prevalence of varicoceles in the erectile dysfunction group (12.7%) was significantly less (P <0.001) than in the infertile group (32.2%). Multivariate logistic regression analysis revealed a statistically significant inverse relationship between body mass index and the presence of a varicocele.
Varicoceles were less likely to be diagnosed among obese men. Although this suggests that the "nutcracker" phenomenon or other biophysical effects of increased adiposity may play a role in the pathogenesis, other factors could not be excluded as contributing to our findings.
精索静脉曲张在15%至20%的男性中存在，是男性不育患者中最常见的异常发现，但关于其病因仍存在争议。轶事经验表明，精索静脉曲张在瘦男性中更为普遍，这支持了肠系膜上动脉在主动脉上方压迫左肾静脉的“胡桃夹”效应。我们在一大群成年人群中检验了这一假设。
1990年至1996年期间，共有2106名男性因不育或勃起功能障碍接受评估。对这些男性进行精索静脉曲张的存在和严重程度检查。使用逻辑回归分析检查年龄、身高、体重指数、评估年份、咨询原因与精索静脉曲张的存在和严重程度之间的关联。
平均年龄为47岁（范围18至85岁），体重指数中位数为26.4 kg/m²（范围15.4至53.3）。398名男性（18.9%）存在精索静脉曲张。按分级分层，59名（14.8%）为III级，155名（38.9%）为II级，184名（46.2%）为I级。勃起功能障碍组中精索静脉曲张的患病率（12.7%）显著低于不育组（32.2%）（P<0.001）。多变量逻辑回归分析显示体重指数与精索静脉曲张的存在之间存在统计学上显著的负相关。
肥胖男性中精索静脉曲张的诊断可能性较小。虽然这表明“胡桃夹”现象或肥胖增加的其他生物物理效应可能在发病机制中起作用，但不能排除其他因素对我们的研究结果有贡献。
