Pampiniform plexus

Varicocele is defined as an abnormal distention of veins in the pampiniform plexus. 

There is still debate about how, when, and to what extent varicocele affects fertility. A total of 10% of all men have a varicocele. Most are both asymptomatic and not associated with infertility. However, among infertile couples the incidence of a varicocele increases to 30% [7]. Why should the dilatation of the veins of the pampiniform plexus impair spermatogenesis A related question in patients with a unilateral varicocele, is how unilateral venous abnormality produces bilateral testicular dysfunction Several theories have been postulated to explain the pathophysiology of varicocele. The most popular among the theories involves the adverse effect of elevated testicular temperature on spermatogenesis [8]. Another theory is that reflux of adrenal or renal metabolites that could inhibit spermatogenesis reach the left testicle by back flow from... 

There are conflicting opinions about the laterality of varicocele. Some authors feel that the condition is predominantly left-sided, with at most 30% of patients having a bilateral problem [9]. In other studies [10, 11], including one in which venograms were performed bilaterally regardless of the physical exam findings [11], bilateral ISV incompetence to an enlarged pampiniform plexus was found in 70%-80% of patients. 

The percutaneous treatment of varicocele is aimed at decreasing the engorgement of the pampiniform plexus by occluding the incompetent ISV and its collaterals. 

Some authors [26] favor the combination of coils and sodium tetradecyl sulfate (Thromboject 3% Omega, Montreal, QC, Canada). The coils are delivered relatively distally, at the level of the inguinal canal, not only to occlude the vein at that level but also to prevent reflux into the pampiniform plexus. The sclerosant is delivered proximal to the coils to occlude all the side branches that could become collaterals. If necessary, coils can also be deposited in the proximal portion of the ISV to prevent pulmonary emboli. One coil that was never used in the... 

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