title: Varicocele is associated with an increase of connective tissue of the pampiniform plexus vein wall.
abstract: OBJECTIVE
  The purpose of this study is to describe the normal structure of spermatic vein wall and the morphological alterations in patients with grades 1-3 varicocele.
  
  
  METHODS
  We dissected and analyzed a 2-3 cm tract of a pampiniform plexus vein of 30 patients undergoing antegrade scrotal sclerotherapy for left varicocele and of 13 consecutive patients undergoing radical orchidectomy for left testis cancer. The histological and morphological examination was performed with hematoxylin-eosin and Azan-Mallory staining through a computer image analysis approach. Vasa vasorum number was evaluated through the anti-CD31 monoclonal antibody.
  
  
  RESULTS
  In normal veins, the tunica media had a circular smooth muscle layer, the tunica adventitia a longitudinal one; oblique fibers connected the longitudinal with the circular layer. In grade 1 varicocele, we found an increase in the connective tissue of the adventitia (39 vs. 1%, P < 0.001) and of the tunica media (13 vs. 0.5%, P = 0.001) and a decrease of oblique fibers. In grade 2 varicocele, the adventitia and media showed greater connective tissue (40 and 15%, P < 0.001). In grade 3 varicocele, adventitia and media showed a further increase in connective tissue (52 and 28%, respectively, <0.001). No oblique fibers were found in these veins. Vasa vasorum were decreased in number in patients with grades I and II varicocele, and were absent in patients with grade III varicocele.
  
  
  CONCLUSIONS
  The wall of pampiniform plexus veins is a complex structure. Varicocele induces a decrease of vasa vasorum number, a fibrotic degeneration of the adventitia and media, and a decrease of the oblique running fibers.
authors.affiliation: Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Monoblocco Ospedaliero, IV Floor, Via Giustiniani 2, Padua 35128, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Iafrate
authors.forename: Antonio
authors.initials: A
authors.lastname: Galfano
authors.forename: Veronica
authors.initials: V
authors.lastname: Macchi
authors.forename: Ebugheme
authors.initials: E
authors.lastname: Ejituru
authors.forename: Gloria
authors.initials: G
authors.lastname: Sarasin
authors.forename: Andrea
authors.initials: A
authors.lastname: Porzionato
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caro
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
mesh_terms: D000328:Adult; D003238:Connective Tissue / Q000473:pathology*; D006801:Humans; D008297:Male; D014646:Varicocele / Q000209:etiology* / Q000473:pathology*; D014680:Veins / Q000473:pathology*; D055815:Young Adult