Top

Published in:

01-06-2009 | Original Article

Varicocele is associated with an increase of connective tissue of the pampiniform plexus vein wall

Authors: Massimo Iafrate, Antonio Galfano, Veronica Macchi, Ebugheme Ejituru, Gloria Sarasin, Andrea Porzionato, Giacomo Novara, Raffaele De Caro, Walter Artibani, Vincenzo Ficarra

Published in: World Journal of Urology | Issue 3/2009

Abstract

Objective

The purpose of this study is to describe the normal structure of spermatic vein wall and the morphological alterations in patients with grades 1–3 varicocele.

Methods

We dissected and analyzed a 2–3 cm tract of a pampiniform plexus vein of 30 patients undergoing antegrade scrotal sclerotherapy for left varicocele and of 13 consecutive patients undergoing radical orchidectomy for left testis cancer. The histological and morphological examination was performed with hematoxylin–eosin and Azan–Mallory staining through a computer image analysis approach. Vasa vasorum number was evaluated through the anti-CD31 monoclonal antibody.

Results

In normal veins, the tunica media had a circular smooth muscle layer, the tunica adventitia a longitudinal one; oblique fibers connected the longitudinal with the circular layer. In grade 1 varicocele, we found an increase in the connective tissue of the adventitia (39 vs. 1%, P < 0.001) and of the tunica media (13 vs. 0.5%, P = 0.001) and a decrease of oblique fibers. In grade 2 varicocele, the adventitia and media showed greater connective tissue (40 and 15%, P < 0.001). In grade 3 varicocele, adventitia and media showed a further increase in connective tissue (52 and 28%, respectively, <0.001). No oblique fibers were found in these veins. Vasa vasorum were decreased in number in patients with grades I and II varicocele, and were absent in patients with grade III varicocele.

Conclusion

The wall of pampiniform plexus veins is a complex structure. Varicocele induces a decrease of vasa vasorum number, a fibrotic degeneration of the adventitia and media, and a decrease of the oblique running fibers.

Ficarra V, Cerruto MA, Liguori G, Mazzoni G, Minucci S, Tracia A, Gentile V (2006) Treatment of varicocele in subfertile men: the Cochrane review—a contrary opinion. Eur Urol 49(2):258–263. doi:10.1016/j.eururo.2005.11.023 PubMedCrossRef

Greenberg SH, Greenberg SH, Lipshultz LI, Morganroth J, Wein AJ (1977) The use of the Doppler stethoscope in the evaluation of varicoceles. J Urol 117(3):296–298PubMed

Howards SS (1984) Varicocele. Fertil Steril 41(3):356–358PubMed

Coolsaet BL (1980) The varicocele syndrome: venography determining the optimal level for surgical management. J Urol 124(6):833–839PubMed

Sofikitis N, Dritsas K, Miyagawa I, Koutselinis A (1993) Anatomical characteristics of the left testicular venous system in man. Arch Androl 30(2):79–85. doi:10.3109/01485019308987738 PubMedCrossRef

Wishahi MM (1991) Anatomy of the venous drainage of the human testis: testicular vein cast, microdissection and radiographic demonstration. A new anatomical concept. Eur Urol 20(2):154–160PubMed

Wishahi MM (1991) Detailed anatomy of the internal spermatic vein and the ovarian vein. Human cadaver study and operative spermatic venography: clinical aspects. J Urol 145(4):780–784PubMed

Tilki D, Kilic E, Tauber R, Pfeiffer D, Stief CG, Tauber R, Ergun S (2007) The complex structure of the smooth muscle layer of spermatic veins and its potential role in the development of varicocele testis. Eur Urol 51(5):1402–1409. doi:10.1016/j.eururo.2006.11.010 PubMedCrossRef

Tanji N, Fujiwara T, Kaji H, Nishio S, Yokoyama M (1999) Histologic evaluation of spermatic veins in patients with varicocele. Int J Urol 6(7):355–360. doi:10.1046/j.1442-2042.1999.00076.x PubMedCrossRef

10.

Lee JD, Jeng SY, Lee TH (2006) Increased expression of hypoxia-inducible factor-1alpha in the internal spermatic vein of patients with varicocele. J Urol 175(3 Pt 1):1045–1048. doi:10.1016/S0022-5347(05)00417-9 PubMedCrossRef

11.

World Health Organization (WHO) (1999) WHO laboratory manual for the examination of human semen and sperm–cervical mucus interaction, 3rd edn. Cambridge University Press, Cambridge

12.

Dubin L, Amelar RD (1977) Varicocelectomy: 986 cases in a twelve-year study. Urology 10(5):446–449. doi:10.1016/0090-4295(77)90132-7 PubMedCrossRef

13.

Ficarra V, Porcaro AB, Righetti R, Cerruto MA, Pilloni S, Cavalleri S, Malossini G, Artibani W (2002) Antegrade scrotal sclerotherapy in the treatment of varicocele: a prospective study. BJU Int 89(3):264–268. doi:10.1046/j.1464-4096.2001.02418.x PubMedCrossRef

14.

Porzionato A, Macchi V, Parenti A, De Caro R (2004) The distribution of mast cells in the human area postrema. J Anat 204:141–147. doi:10.1111/j.1469-7580.2004.00256.x PubMedCrossRef

15.

Bucciante L (1965) Microscopie optique de la paroi veineuse. Symp. Int morphologie histochimie paroi vascularie, Friburg, Part III, pp 211–308

16.

Ohh M, Park CW, Ivan M, Hoffman MA, Kim TY, Huang LE, Pavletich N, Chau V, Kaelin WG (2000) Ubiquitination of hypoxia-inducible factor requires direct binding to the beta-domain of the von Hippel-Lindau protein. Nat Cell Biol 2(7):423–427. doi:10.1038/35017054 PubMedCrossRef

17.

Falanga V, Zhou L, Yufit T (2002) Low oxygen tension stimulates collagen synthesis and COL1A1 transcription through the action of TGF-beta1. J Cell Physiol 191(1):42–50. doi:10.1002/jcp.10065 PubMedCrossRef

18.

Zimmer M, Doucette D, Siddiqui N, Iliopoulos O (2004) Inhibition of hypoxia-inducible factor is sufficient for growth suppression of VHL^−/− tumors. Mol Cancer Res 2(2):89–95PubMed

Title: Varicocele is associated with an increase of connective tissue of the pampiniform plexus vein wall
Authors: Massimo Iafrate
Antonio Galfano
Veronica Macchi
Ebugheme Ejituru
Gloria Sarasin
Andrea Porzionato
Giacomo Novara
Raffaele De Caro
Walter Artibani
Vincenzo Ficarra
Publication date: 01-06-2009
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 3/2009
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-008-0352-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Varicocele is associated with an increase of connective tissue of the pampiniform plexus vein wall

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2009

Quantification of the survival benefit of early versus deferred cystectomy in high-risk non-muscle invasive bladder cancer (T1 G3)

IL-10 −1082 G>A: a risk for prostate cancer but may be protective against progression of prostate cancer in North Indian cohort

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

The present and future burden of urinary bladder cancer in the world

Extraperitoneal laparoscopic adenomectomy for benign prostatic hyperplasia

Connexin45 expression in the human obstructed detrusor muscle