Shi Shuibo, Chen Weikang, Tian Junjie, Liang Zhongyan, Wu Jinggen, Li Jingping, Li Lejun, Zhang Fengbin
Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Transl Androl Urol. 2025 Jun 30;14(6):1807-1817. doi: 10.21037/tau-2025-120. Epub 2025 Jun 26.
Varicocele is characterized by the dilation and tortuosity of the internal spermatic venous plexus, leading to impaired venous return, elevated testicular temperature, and ultimately compromised sperm quality. However, most previous reviews have primarily focused on the impact of varicocele on fertility, with limited comprehensive analysis of the associated risk factors contributing to its development. Therefore, this study systematically reviews the existing literature and provides an in-depth analysis of the risk factors associated with varicocele.
We conducted a literature search using PubMed, selecting peer-reviewed journal articles without time restrictions. The included publications were systematically summarized and analyzed.
Varicocele predominantly occurs on the left side (90%) due to anatomical factors such as the longer left spermatic vein and its perpendicular insertion into the left renal vein, increasing hydrostatic pressure. Genetic predispositions, including polymorphisms in glutathione S-transferase (GST) and NOS3 genes, contribute to oxidative stress and venous dysfunction. Lifestyle factors such as rapid pubertal development, intense physical activity, and high-altitude residence correlate with higher incidence, while higher body mass index (BMI) may be protective. Hematological markers, including elevated platelet indices and inflammatory cytokines such as interleukin-6 (IL-6) and C-reactive protein (CRP) are linked to varicocele severity and infertility risk. Additionally, conditions like chronic obstructive pulmonary disease (COPD), chronic constipation, and autoimmune diseases like Behçet's disease exacerbate varicocele through increased intra-abdominal pressure or vascular inflammation.
Varicocele is a condition with multiple contributing factors. Identifying high-risk individuals early, along with lifestyle changes and targeted treatments, may help reduce fertility problems linked to varicocele. Future research should focus on better understanding how this condition develops and improving treatment options to enhance outcomes or prevent it altogether.
精索静脉曲张的特征是精索内静脉丛扩张和迂曲，导致静脉回流受损、睾丸温度升高，最终损害精子质量。然而，以往大多数综述主要关注精索静脉曲张对生育能力的影响，对其发生的相关危险因素的综合分析有限。因此，本研究系统回顾现有文献，深入分析与精索静脉曲张相关的危险因素。
我们使用PubMed进行文献检索，选择无时间限制的同行评审期刊文章。对纳入的出版物进行系统总结和分析。
由于左侧精索静脉较长且垂直汇入左肾静脉等解剖因素，增加了静水压力，精索静脉曲张主要发生在左侧（90%）。遗传易感性，包括谷胱甘肽S-转移酶（GST）和NOS3基因的多态性，会导致氧化应激和静脉功能障碍。青春期快速发育、剧烈体育活动和高海拔居住等生活方式因素与较高的发病率相关，而较高的体重指数（BMI）可能具有保护作用。血液学指标，包括血小板指数升高以及白细胞介素-6（IL-6）和C反应蛋白（CRP）等炎症细胞因子与精索静脉曲张的严重程度和不孕风险有关。此外，慢性阻塞性肺疾病（COPD）、慢性便秘以及白塞病等自身免疫性疾病等情况会通过增加腹内压或血管炎症加重精索静脉曲张。
精索静脉曲张是一种由多种因素导致的疾病。早期识别高危个体，同时改变生活方式并进行针对性治疗，可能有助于减少与精索静脉曲张相关的生育问题。未来的研究应专注于更好地理解这种疾病的发病机制，并改善治疗方案以提高治疗效果或完全预防该病。
