Insight On The Pathogenesis Of Varicoceles: Relationship Of Varicocele And Body Mass Index

Main Category: Urology / Nephrology
Also Included In: Obesity / Weight Loss / Fitness;  Fertility;  Men's health
Article Date: 15 Sep 2006 - 0:00 PST

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UroToday.com - The authors have retrospectively analyzed the incidence of varicoceles in men (n=2106) who were referred for evaluation of infertility or erectile dysfunction from 1990 - 1996.

The presence of varicoceles was determined on the basis of physical examination.

Height and weight determinations were recorded and BMI's were calculated.

The overall incidence of varicoceles was 18.9% (n=398 men). 32% of the infertile men had varicoceles as compared to 12.7% in the ED group.

Obesity was found to be protective against the diagnosis of varicocele in each group.

The authors believe that this observation supports the "nut cracker" hypothesis of the pathogenesis of the varicocele as a result of the adipose tissue protecting against compressive forces.

Editorial comment:

This is an interesting observation however there are significant limitations as pointed out by the authors. Perhaps most significantly is the difficulty of the examination in obese men. The authors argue against this based upon varicocele grade distribution. That being said, then why would the distribution of grade be the same if there were a protective effect of excess adipose tissue? Although all were examined in the same fashion, this population may require ultrasound evaluation to preclude confounding factors in the assessment of obese individuals.

Matthew E Nielsen, Stephen Zderic, Stephen Freedland, and Jonathan P. Jarow
Urology 2006 Aug;68(2):392-6.

Harris M. Nagler, MD
Chair,
Berger Department of Urology
Chief of Graduate Medical Education/Academic Affairs

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