Varicocele and varicose veins compared. A basis for logical surgery.

In the past only large symptomatic varicoceles were treated surgically, but this has changed now that they are believed to be a cause for infertility. Ten patients have been studied using the Doppler flowmeter and phlebography to compare varicoceles and varicose veins in the legs and to decide whether or not the same principles apply in their surgical treatment. These studies have confirmed a similar mechanism of retrograde flow from above a pumping mechanism to below it. Surgery must aim at effective and complete interruption of the source of the downflow. This requires ligation of the testicular vein either at sufficiently high level to insure that it is above any major branches or that these are included in the ligation. There is no danger of causing venous obstruction because a varicocele would not develop without the existence of a massive alternative venous outlet.