Oxidative stress, nitric oxide and inflammation in the pathophysiology of varicocele and the effect of hydrogen sulfide as a potential treatment

Varicocele is defined as the non-palpable enlargement of the spermatic venous plexus, which has implications on the sperm quality and fertility. The guidelines for managing varicocele in adolescents are not fully determined yet. However, based on the recent reports, during varicocele injuries to testicular tissues may be a result of the formation of reactive oxygen species (ROS) and the subsequent oxidative damage. The testis has a high metabolism rate and cell replication which itself causes excessive production of the ROS and decreases antioxidant capacity. Massive generation of ROS and their interaction with lipids, proteins and nucleic acids has adverse effects on the normal cell function. This review article describes the varicocele, its etiology, pathophysiological mechanisms and current treatment methods. An electronic search has been conducted, during 2018, via PubMed and Medline database English literature. Peer-reviewed articles were targeted and the following key-words were used: varicocele, diagnosis, etiology, cellular and molecular mechanisms. Available full-text articles were read. Related articles were also scrutinized. A hand search was also driven. Taken together, this review article mention three main pathophysiology of varicocele that can be treated by natural antioxidant. In addition, hydrogen sulfide as another factor was discussed because the reduction of this substance contribute to the male infertility which induce by varicocele.