About Vericocele

[Guest guest]

Dear Ayurvedic Doctors and friends....!

 

I am from Saudia Arabia. One of my friend told me that he have

vericocele. But I dont know what is that....

 

Anybody can explain me what is it, its symptoms, its dangerous

effects, its curable methods in Ayurvedics,etc......

 

Expecting for your valuable advice.

 

 

Thank you......

 

 

Ashiq

[Guest guest]

hello ,

I have just posted this article which i copied from the internet

It might give some information and help

 

 

 

pl read below:

 

Varicocele

Last Updated: July 20, 2004

 

 

Synonyms and related keywords: varicoceles, scrotal varicocele,

varicocelectomy, pampinocele, pampiniform venous plexus, spermatic

vein, arrest of sperm secretion, male fertility, male infertility,

low sperm count, poor sperm function, dilation of the pampiniform

venous plexus, testicular vein, antireflux valve, spermatogonia,

Valsalva maneuver, sperm production, sperm function, testicular pain,

scrotal pain, testicular swelling, scrotal swelling, spermatogenesis,

infertility, fertility treatment, male factor infertility,

infertility treatment

 

AUTHOR INFORMATION Section 1 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author: Edward David Kim, MD, Associate Professor, Department of

Urology, University of Tennessee School of Medicine

 

Edward David Kim, MD, is a member of the following medical societies:

American College of Surgeons, American Medical Association, American

Society for Reproductive Medicine, American Society of Andrology,

American Urological Association, Illinois State Medical Society, and

Texas Medical Association

 

Editor(s): Gamal Mostafa Ghoniem, MD, FACS, Fellowship Program, Clinical Professor of Surgery, Head, Section of Voiding

Dysfunction, Female Urology and Reconstruction, Cleveland Clinic

Florida; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor,

Pharmacy, eMedicine; Mark Jeffrey Noble, MD, Consulting Staff,

Urologic Institute, Cleveland Clinic Foundation; J Stuart Wolf, Jr,

MD, Director of Michigan Center for Minimally Invasive Urology,

Associate Professor, Department of Urology, University of Michigan

Medical Center; and Stephen W Leslie, MD, FACS, Founder and Medical, Lorain Kidney Stone Research Center, Clinical Assistant

Professor, Department of Urology, Medical College of Ohio

INTRODUCTION Section 2 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

A varicocele is a dilation of the pampiniform venous plexus and the

internal spermatic vein. Varicocele is a well-recognized cause of

decreased testicular function and occurs in approximately 15-20% of

all males and in 40% of infertile males. Understanding the

significance of this anatomic abnormality in the infertile patient

requires a brief review of the history, background, and current

concepts of functional anatomy, as well as the methods and results of

surgical repair.

 

History of the Procedure: Varicocele was first recognized as a

clinical problem in the 16th century. Ambroïse Paré

(1500–1590), the

most celebrated surgeon of the Renaissance, described this vascular

abnormality as the result of melancholic blood. Barfield, a British

surgeon, first proposed the relationship between infertility and

varicocele in the late 19th century. Shortly thereafter, other

surgeons reported an association of varicocele with an arrest of

sperm secretion and the subsequent restoration of fertility following

repair. Through the early 1900s, reports by other surgeons continued

to describe the association of varicocele with infertility.

 

In the 1950s, after a report of fertility following varicocele repair

in an individual known to be azoospermic (ie, without sperm), the

idea of surgically correcting varicoceles as a clinical approach to

certain kinds of male infertility gained support among American

surgeons. Research continued, which led to many published studies

that associated varicoceles with impaired semen quality.

 

In these studies, researchers documented a recurrent pattern of low

sperm count, poor motility, and predominance of abnormal sperm forms;

this became known as the stress pattern of semen. Although not

synonymous or specific for varicocele, the term suggests early

evidence of testicular damage. Urologists then began to evaluate male

infertility through the study of sperm, which are evaluated for their

number (sperm count), percentage of motile forms, forward movement or

motility, and morphology (shape or form), and semen.

 

Problem: A varicocele is a dilation of the pampiniform venous plexus

within the scrotum. Varicoceles may be present in 15-20% of the

normal fertile male population; however, 40% of infertile men may

have them. How a varicocele impairs sperm structure, function, and

production is unknown, but researchers believe it interferes with

testicular thermoregulation.

 

 

Frequency: Although varicoceles appear in approximately 20% of the

general male population, they occur significantly more often in the

subfertile population (40%). In fact, scrotal varicoceles are the

most common cause of poor sperm production and decreased semen

quality. Varicoceles are easy to identify, and they are easy to

surgically correct.

 

Etiology: Varicoceles are much more common (~80-90%) in the left

testicle than in the right because of several anatomic factors,

including (1) the angle at which the left testicular vein enters the

left renal vein, (2) the lack of effective antireflux valves at the

juncture of the testicular vein and renal vein, and (3) the increased

renal vein pressure due to its compression between the superior

mesenteric artery and the aorta (ie, nutcracker effect). Also of

importance is that a one-sided varicocele can often affect the

opposite testicle.

 

Varicoceles vary in size and can be classified into the following 3

groups:

 

 

Large - Easily identified by inspection alone

 

Moderate - Identified by palpation without bearing down (Valsalva

maneuver)

 

Small - Identified only by bearing down, which increases intra-

abdominal pressure, thus impeding drainage and increasing varicocele

size

 

Pathophysiology: Several theories have been proposed to explain the

harmful effect of varicoceles on sperm quality, including the

possible effects of pressure, oxygen deprivation, heat injury, and

toxins.

 

Despite considerable research, none of the theories has been proved

unquestionably, although an elevated heat effect caused by impaired

circulation appears to be the most reproducible defect. Supporting

this hypothesis is the fact that a varicocele created in an

experimental animal led to poor sperm function with elevated

intratesticular temperature. Regardless of the mechanism of action, a

varicocele is indisputably a significant factor in decreasing

testicular function and in reducing semen quality in a large

percentage of men seeking infertility treatment.

 

Clinical: A patient with a varicocele is usually asymptomatic and

often seeks care for an evaluation of his role in a couple

experiencing infertility. Sometimes, he also may report scrotal pain

or heaviness. Careful physical examination remains the primary method

of varicocele detection. An obvious varicocele is often described as

feeling like a bag of worms. INDICATIONS Section 3 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

The results of treating varicoceles in adolescents are not as clear

as the results of treating varicoceles in adults. Although

varicoceles first become apparent in adolescence, their natural

history and its timeline for the onset of detrimental effects on

testicular function remain unclear. Varicoceles occur in

approximately 10-15% of the fertile male population, but not all

varicoceles impair sperm function, overall semen quality, or

fertility.

 

Important determinations to be made regarding varicoceles in

adolescents are whether (1) the varicocele is a progressive lesion

and (2) early repair of the varicocele prevents the development of

infertility.

 

In 1977, Lipshultz and Corriere suggested that varicoceles were

associated with testicular atrophy that was progressive with age.

They also observed that testicular biopsy specimens taken from

prepubertal boys with varicoceles already revealed histologic

abnormalities.

 

In 1987, Kass and Belman were the first to demonstrate a significant

increase in testicular volume after varicocele repair in adolescents.

Although Kass and Belman noted catch-up growth, they did not study

semen parameters. Collecting a semen sample from an adolescent is not

always easy; consequently, studying the effects of a varicocele and

the benefits of treatment is difficult.

 

The indications for repairing varicoceles in adolescents include the

presence of significant testicular asymmetry (>20%) demonstrated on

serial examinations, testicular pain, and abnormal semen analysis

results. Very large varicoceles also may be repaired; however, in the

absence of atrophy, this indication is relative and controversial.

 

RELEVANT ANATOMY AND CONTRAINDICATIONS Section 4 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

Relevant Anatomy: The testes are the paired male genital organs that

contain sperm, cells that produce and nourish sperm (spermatogonia

and Sertoli cells, respectively), and cells that produce testosterone

(Leydig cells). The testes are located in a sac called the scrotum.

The epididymis is a small, tubular structure attached to the testes

that serves as a storage reservoir wherein sperm mature.

 

Sperm travel through the vas deferens, which connects the epididymis

to the prostate gland. The vas deferens is in the scrotum and is part

of a larger tissue bundle called the spermatic cord. The spermatic

cord contains the vas deferens, blood vessels, nerves, and lymphatic

channels.

 

The pampiniform plexus is composed of the veins of the spermatic

cord. These veins drain blood from the testes, epididymis, and vas

deferens and eventually become the spermatic veins that drain into

the main circulation of the kidneys. The pampiniform venous plexus

may become tortuous and dilated, much like a varicose vein in the

leg. In fact, a scrotal varicocele is simply a varicose enlargement

of the pampiniform plexus above and around the testicle. Two other

veins, the cremasteric and the deferential, also drain blood from the

testicles; however, they are rarely involved in the varicocele

process.

 

Image 1 illustrates the basic anatomy.

 

Contraindications: Opinions vary regarding the value of repairing

subclinical varicoceles in infertile men, but most experts do not

recommend it.

 

Quick Find

Author Information

Introduction

Indications

Relevant Anatomy And Contraindications

Workup

Treatment

Complications

Outcome And Prognosis

Future And Controversies

Pictures

Bibliography

 

Click for related images.

 

Continuing Education

CME available for this topic. Click here to take this CME.

 

 

Patient Education

Men's Health Center

 

Testicular Pain Overview

 

Testicular Pain Causes

 

Testicular Pain Symptoms

 

Testicular Pain Treatment

 

Understanding the Male Anatomy

 

 

 

 

 

 

 

 

 

WORKUP Section 5 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

Lab Studies:

 

 

When the clinical examination findings are equivocal, high-resolution

color-flow Doppler ultrasonography is the diagnostic method of

choice. If a patient has sudden onset of a varicocele, a single right-

sided varicocele, or any varicocele that is not reducible in the

supine position, consider possible retroperitoneal pathology (eg,

renal cell carcinoma) as the cause of spermatic vein compression.

Investigate further with appropriate ultrasound or CT scans before

repairing the varicocele.

Although varicocele diagnosis may be assisted using a number of

methods (eg, venography, radionuclide angiography, thermography,

ultrasonography), the current standard of care is high-resolution

color-flow Doppler ultrasonography. High-resolution real-time scrotal

ultrasonography using a 7- to 10-MHz probe defines a varicocele as a

hollow tubular structure that increases in size following a Valsalva

maneuver.

Color-flow Doppler ultrasonography defines the anatomic and

physiologic aspects of varicoceles by using real-time ultrasonography

and pulsed Doppler in the same scan. The color of the signal

identifies the blood flow and direction within the varicocele. The

characteristic reverse flow of varicoceles is confirmed by prolonged

flow augmentation within a colored flow area; the flow changes color

(ie, reverses) on real-time imaging.

Although the exact size definition is controversial, most surgeons

consider a varicocele to be a vein 3 mm in diameter or larger while

the patient is at rest. McClure et al define a varicocele as the

presence of 3 or more veins, with 1 having a minimum resting diameter

of 3 mm or an increase in venous diameter with the Valsalva maneuver.

Because other surgeons use 2-3 mm as a cutoff, comparing results of

these ultrasound-based varicocelectomy studies is difficult.

TREATMENT Section 6 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

Medical therapy: A varicocele is an anatomic abnormality that can

impair sperm production and function. No effective medical treatments

for varicoceles have been identified. While some investigators are

evaluating the role of antioxidants for the treatment of elevated

levels of reactive oxygen species, this treatment approach is still

experimental.

 

Surgical therapy: The primary form of treatment for varicoceles is

surgery. Because of the potential to cause significant testicular

damage, evaluate the varicocele during the physical examination. The

presence of a varicocele does not mean surgical correction is

necessary.

 

Reasons for surgical correction of a diagnosed variocele include

relieving significant testicular discomfort or pain not responsive to

routine symptomatic treatment, reducing testicular atrophy (volume

<20 mL, length <4 cm), and addressing the possible contribution to

unexplained male infertility. A varicocele may cause progressive

damage to the testes, resulting in further atrophy and impairment of

seminal parameters.

 

A scrotal varicocele is the most correctable factor in a male with

poor semen quality; therefore, seriously consider surgical correction

in an infertile male with abnormal semen quality.

 

Preoperative details: Perform varicocele surgery in an outpatient

setting using one of a variety of anesthetics (eg, general, regional,

local). A general anesthetic provides maximal patient comfort.

 

Intraoperative details: The 3 common surgical approaches to correct a

scrotal varicocele are transinguinal (groin), retroperitoneal

(abdominal), and infrainguinal/infrapubic (below the groin). The

preferred technique is the transinguinal approach using optical

magnification (with loupes or an operating microscope) to ensure

precise identification of all contributory veins and testicular

arteries.

 

With all 3 approaches, all abnormal veins are tied permanently to

prevent continued abnormal blood flow (see Image 2). Avoid the vas

deferens and the testicular artery during the surgery.

 

Use the retroperitoneal or infrapubic approach in patients who have

already had an attempted varicocele or hernia repair, which may have

caused considerable scarring in the groin. These 2 approaches also

may be used in patients who have not had attempted repairs.

 

Two approaches used less commonly are the percutaneous transvenous

and the laparoscopic routes. An interventional radiologist may

perform the percutaneous transvenous route, but, because of

potentially greater risks, this approach is reserved for patients

with recurrent varicoceles. Similarly, the laparoscopic route has

potential risks and few benefits over the transinguinal approach.

 

Postoperative details:

 

Patient instructions

 

 

Varicocele surgery is usually performed in an outpatient setting (ie,

day-surgery unit). Patients may return to normal, nonstrenuous

activities (eg, work) after 2 days.

 

All outer dressings are removed 48 hours after surgery. The small

strips of tape (Steri-Strips) are left in place for 7-10 days before

removal.

 

Inform patients that bathing or showering is permitted 48 hours after

surgery.

 

A normal, well-balanced diet can be resumed when patients return

home. Advise patients to start with fluids and gradually return to

solid foods.

 

Prescribe pain medication and advise patients to take as directed.

After 2 days, patients may take nonprescription acetaminophen (eg,

Tylenol) or ibuprofen (eg, Advil, Motrin) to relieve discomfort.

 

Patients can engage in normal, nonstrenuous activity when they feel

up to it. If activity causes discomfort, it should be discontinued.

Patients can resume more strenuous activities (eg, weightlifting,

jogging) after 2 weeks.

 

Advise patients to refrain from intercourse for 1 week.

Common discomforts and symptoms that do not require medical attention

 

Patients may experience some postoperative discomfort. Complications

are rare. Common discomforts or symptoms do not require a doctor's

attention and may include the following:

 

 

Minor bruising and slight discoloration may appear around the groin

incisions but are self-limited.

 

The sensation of hardness around and beneath the incision site

resolves in approximately 3 weeks.

 

The slight redness and tenderness around the incision from the normal

healing process resolves in a few days.

 

A very small amount of thin, clear, pinkish fluid drains from the

incision for a few days after the procedure. Advise patients to keep

the area clean and dry.

 

A sore throat, headache, nausea, constipation, and general body ache

occur because of the surgical procedure and anesthetic. Advise

patients that these problems resolve within 24 hours.

Postoperative complications that require prompt medical attention

 

 

If wounds become infected (3-5 d after surgery usually), antibiotics

may be necessary. Wounds can become warm, swollen, red, and painful,

with significant drainage from the incision site, and patients may

develop fever.

 

Hematomas may form. Extreme discoloration around the abdominal

incisions results from bleeding underneath the skin, which causes

throbbing pain and bulging wounds.

Follow-up care: Check the patient's semen 3-4 months after surgery.

Because spermatogenesis requires approximately 72 days, any effects

from the varicocele repair on semen analysis results are delayed.

 

Patient instructions

 

 

The patient returns to the clinical office for a wound evaluation in

approximately 7-10 days.

 

Schedule a follow-up examination for a wound check and varicocele

examination for 8 weeks after surgery.

 

Schedule a semen analysis and consultation for 4 months after

surgery. At this time, the timing of subsequent appointments can be

discussed.

For excellent patient education resources, visit eMedicine's Men's

Health Center. Also, see eMedicine's patient education articles

Understanding the Male Anatomy and Testicular Pain.

 

COMPLICATIONS Section 7 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

The prevalence of adverse effects following varicocele repair is

remarkably low. Hydrocele or increased fluid around the testicles

occurs in 2-5%. Successful surgery often increases conception rates

in infertile couples. The overall recurrence rate for varicoceles has

been reported as high as 10%.

 

Although unproved, a varicocele may represent a progressive lesion

that can have detrimental effects on testicular function. An

untreated varicocele, especially when large, may cause long-term

deterioration in sperm production and even testosterone production.

If varicoceles are present bilaterally in an infertile male, repair

both to improve sperm quality.

 

In a patient in whom a varicocele is first identified during a

vasectomy reversal, do not perform the varicocelectomy at the time of

the vasectomy reversal. Delaying the varicocelectomy preserves some

venous return in these patients and avoids possible injury to the

testicular artery. If necessary, repair the varicocele 6 months

later, after new vascular channels form.

 

OUTCOME AND PROGNOSIS Section 8 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

Following varicocelectomy, approximately 66-70% of patients have

improved bulk semen parameters and 40-60% of patients have increased

conception rates. Because human spermatogenesis takes approximately

72 days, the first improvements in semen analysis results typically

are not apparent until 3-4 months after surgery.

 

While many of the studies are retrospective, a randomized,

prospective, controlled study by Magdar and associates confirmed that

varicocelectomy is an effective treatment for male subfertility.

Magdar et al studied male counterparts in couples in 2 subject

groups, groups A and B. Group A (20 male subjects with varicoceles)

was studied for 1 year, and only 2 (10%) men initiated a pregnancy.

Those male subjects who could not initiate a pregnancy then had

varicocele repairs; within 2 years, 12 (66%) were successful in

initiating a pregnancy.

 

Meanwhile, 25 male subjects in group B had varicocele repairs

immediately. Within the first year, 15 (60%) initiated a pregnancy.

After 3 years, pregnancy was achieved in an additional 4 (16%)

subjects. Semen parameters improved in all subjects who underwent

varicocele repair, regardless of pregnancy occurrence. Semen

parameters were unchanged for those group A subjects during their 1

year of observation. This important study concluded that varicoceles

are associated with reduced fertility and impaired testicular

function, while repair improves sperm parameters and fertility rates.

In addition, Vasquez-Levin et al recently demonstrated that

varicocele repair benefits sperm morphology, even when evaluated by

so-called strict criteria.

 

FUTURE AND CONTROVERSIES Section 9 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

In 1992, researchers introduced a new micromanipulation technique

known as intracytoplasmic sperm injection (ICSI). With ICSI, surgeons

inject a single spermatozoon into an oocyte to initiate fertilization

and, eventually, a pregnancy. With the success of this technique,

some researchers question the need for varicocele repair.

 

Conversely, a cost-analysis study by Schlegel shows the significant

cost advantage of varicocele repair over ICSI. In addition,

varicocele repair has the potential for improving the male factor,

rather than using unknown sperm. ICSI also involves in vitro

fertilization, which carries some risk for the female who donates

surgically removed eggs.

 

Another current topic focuses on the benefit of varicocele repair in

men who are azoospermic or severely oligospermic. A study indicates

that varicocele repair is somewhat beneficial, even for men with this

severe spermatogenic impairment.

 

Other concerns focus on the benefit of varicocele repair in infertile

men with poor semen quality who have only ultrasound evidence of a

varicocele. While opinions differ about the value of repairing

subclinical varicoceles in infertile men, most experts do not

recommend it.

 

PICTURES Section 10 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

Caption: Picture 1. A large varicocele is seen through the scrotal

skin. In a patient with a varicocele, the dilated vessels of the

pampiniform plexus are easily appreciated within the scrotum.

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Picture Type: Image

Caption: Picture 2. Incision for an inguinal approach to varicocele

repair.

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Picture Type: Photo

BIBLIOGRAPHY Section 11 of 11

Author Information Introduction Indications Relevant Anatomy And

Contraindications Workup Treatment Complications Outcome And

Prognosis Future And Controversies Pictures Bibliography

 

 

 

 

 

Goldstein M, Gilbert BR, Dicker AP, et al: Microsurgical inguinal

varicocelectomy with delivery of the testis: an artery and lymphatic

sparing technique. J Urol 1992 Dec; 148(6): 1808-11[Medline].

Kass EJ, Belman AB: Reversal of testicular growth failure by

varicocele ligation. J Urol 1987 Mar; 137(3): 475-6[Medline].

Kim ED, Leibman BB, Grinblat DM, Lipshultz LI: Varicocele repair

improves semen parameters in azoospermic men with spermatogenic

failure. J Urol 1999 Sep; 162(3 Pt 1): 737-40[Medline].

Lipshultz LI, Corriere JN Jr: Progressive testicular atrophy in the

varicocele patient. J Urol 1977 Feb; 117(2): 175-6[Medline].

Madgar I, Weissenberg R, Lunenfeld B, et al: Controlled trial of high

spermatic vein ligation for varicocele in infertile men. Fertil

Steril 1995 Jan; 63(1): 120-4[Medline].

Marks JL, McMahon R, Lipshultz LI: Predictive parameters of

successful varicocele repair. J Urol 1986 Sep; 136(3): 609-12

[Medline].

Marmar JL, Kim Y: Subinguinal microsurgical varicocelectomy: a

technical critique and statistical analysis of semen and pregnancy

data. J Urol 1994 Oct; 152(4): 1127-32[Medline].

McClure RD, Khoo D, Jarvi K, Hricak H: Subclinical varicocele: the

effectiveness of varicocelectomy. J Urol 1991 Apr; 145(4): 789-91

[Medline].

Rigano E, Santoro G, Impellizzeri P, et al: Varicocele and sport in

the adolescent age. Preliminary report on the effects of physical

training. J Endocrinol Invest 2004 Feb; 27(2): 130-2[Medline].

Sawczuk IH, Hensle TW, Burbige KA, Nagler HM: Varicoceles: Effect on

testicular volume in prepubertal and pubertal males. Urology 1993;

41: 466-468[Medline].

Schlegel PN: Is assisted reproduction the optimal treatment for

varicocele-associated male infertility? A cost effective analysis.

Urology 1997; 49: 83-90[Medline].

Steckel J, Dicker AP, Goldstein M: Relationship between varicocele

size and response to varicocelectomy. J Urol 1993 Apr; 149(4): 769-71

[Medline].

Vazquez-Levin MH, Friedmann P, Goldberg SI, et al: Response of

routine semen analysis and critical assessment of sperm morphology by

Kruger classification to therapeutic varicocelectomy. J Urol 1997

Nov; 158(5): 1804-7[Medline].

Wang C, McDonald V, Leung A, et al: Effect of increased scrotal

temperature on sperm production in normal men. Fertility and

Sterility 1997; 68: 334-339[Medline].

Witt MA, Lipshultz LI: Varicocele: a progressive or static lesion?

Urology 1993 Nov; 42(5): 541-3[Medline].

 

 

 

 

 

 

 

 

ayurveda, "ashiq_mon"

<ashiq_mon> wrote:

> Dear Ayurvedic Doctors and friends....!

>

> I am from Saudia Arabia. One of my friend told me that he have

> vericocele. But I dont know what is that....

>

> Anybody can explain me what is it, its symptoms, its dangerous

> effects, its curable methods in Ayurvedics,etc......

>

> Expecting for your valuable advice.

>

>

> Thank you......

>

>

> Ashiq