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Acta Phlebologica 2002 August;3(2):59-63

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

The haemodynamic alteration of the subdiaphragmatic venous functional unit and its role in the etiopathogenesis of the idiopathic varicocele

Gioffrè L. 1, Bosco M. R. 1, Meloni V. 1, Vietri F. 1, Menchini Fabris G. F. 2

1 Cattedra di Chirurgia Generale, Dipartimento di Scienze Chirurgiche e Tecnologie Mediche Applicate, Università degli Studi “La Sapienza”, Roma; 2 Unità Operativa Autonoma di Andrologia, Dipartimento di Medicina della Procreazione e dell’Età Evolutiva, Università degli Studi di Pisa, Pisa


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The aim of ­this ­work was to clear­ly illus­trate ­that the hae­mod­y­nam­ic path­o­gen­e­sis of the varic­o­cele can be a con­se­quence of a ret­ro­grade ­flux ­along the inter­nal sper­mat­ic ­vein. The ­reflux is due to the use of a dif­fer­ent ­path of ­flow ­along the inter­nal sper­mat­ic ­vein ­which ­uses ­some col­lat­er­al ­routes of the ves­sel, and main­ly the neph­ro­gen­i­tal ­branch. The dimin­ish­ing pres­sure in the ­final seg­ment of the inter­nal sper­mat­ic ­vein is the ­focal ­point of the path­o­gen­e­sis of the dis­ease. The onto­ge­net­ic pro­cess ­leading to the for­ma­tion of the ­left ­renal ­vein ­help that ­lead in explain­ing the ­almost gen­er­al one-sid­ed­ness of the dis­or­der, its fre­quen­cy and the ­fact ­that it is most­ly the ­young who are affect­ed by it. In ­fact, the var­i­abil­ity of the tim­ing and of the exten­sion of the invo­lu­tion of the prim­i­tive ­venous ­system and of the pro­cess­es of evo­lu­tion ­which ­lead to the mor­pho­log­i­cal def­i­ni­tion of the ­tracts of the gen­i­tal ­flow ­down, ­lead to the var­i­ous man­i­fes­ta­tions of the idiopath­ic varic­o­cele. This the­o­ry ­which ­also ­takes ­into ­account the phys­io­log­i­cal mech­a­nism of the ­venous drain­age of the tes­ti­cle in an ­anti-grav­i­ta­tion ­sense is ­part of the pat­terns ­that, ­under the dia­phragm, ­rule the ­entire ­venous ­return of the ­blood ­toward to the ­heart.

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