Varicocele is a prevalent cause of male infertility and has been associated with erectile dysfunction in clinical and preclinical studies, characterized by a complex pathophysiological process involving immune-inflammatory responses. This review focuses on the preclinically supported immune-inflammatory interactions between the testicular and penile microenvironments in varicocele patients, systematically summarizing the plausible and partially validated molecular mechanisms mediating erectile dysfunction and spermatogenic impairment. We explore the network relationships among local and systemic inflammatory cytokines, immune cell infiltration, oxidative stress, endothelial dysfunction, and neurovascular injury. By integrating recent omics studies, animal models, and available clinical data, this article elucidates the hypothetical and mechanistically plausible pathological linkage from abnormal varicose veins in the pampiniform plexus to distal impairment of penile cavernous function. The review aims to synthesize and contextualize the systemic impact of varicocele and to establish a theoretical foundation for developing targeted therapies addressing immune-inflammatory pathways.

Testicular biopsy represents a crucial procedure in the management of non-obstructive azoospermia, though its success remains variable. [cite: 106] Identifying predictive factors for successful sperm retrieval is essential for patient selection. [cite: 107] Aim: To determine the clinical, hormonal and technical factors predictive of successful testicular biopsy in azoospermic patients [cite: 108] Methods: A retrospective analytical study was conducted over 5 years (2017-2021), including 28 patients. [cite: 109] Comparative analysis was performed between groups with successful (spermatozoa present) and failed biopsy. [cite: 110] Results: Significant predictive factors for successful biopsy included: testicular volume preservation (p=0.042), low FSH levels (p=0.002), low estradiol levels (p=0.018), excretory azoospermia type (p=0.023), and unilateral surgical approach (p=0.005). [cite: 111] Clinical varicocele and hydrocele showed no significant correlation. [cite: 112] Conclusion: Our study identifies a predictive profile for testicular biopsy success, enabling better patient selection and surgical strategy optimization in assisted reproductive technology. [cite: 113].

Polyorchidism, the presence of more than two testes, remains the rarest congenital anomaly of the male gonads, with fewer than 300 histologically or radiologically confirmed cases reported worldwide. Most supernumerary testes are discovered incidentally during imaging or surgery, yet their detection raises critical questions about malignancy risk, reproductive potential, and appropriate management. Current evidence indicates that approximately 90% of patients have three testes and two‑thirds show left‑sided duplication. About 75% of supernumerary testes are scrotal, roughly one‑fifth lie in the inguinal canal, and a small minority are abdominal or retroperitoneal. Inguinal hernia, cryptorchidism, and torsion are the most frequent associated anomalies, whereas hydrocele, varicocele, and renal agenesis occur less often. The pooled risk of neoplastic transformation ranges from 1% to 7% overall but climbs to 15% to 20% when the supernumerary testis is undescended. High‑resolution ultrasound is the diagnostic mainstay, while magnetic resonance imaging is indispensable for extrascrotal lesions and for clarifying drainage patterns. Contemporary practice increasingly favors surveillance of scrotal, anatomically normal, vas‑draining supernumerary testes, whereas extrascrotal, non‑draining, dysgenetic, or radiologically suspicious lesions warrant orchiectomy. Fertility outcomes remain poorly characterized. Isolated reports document both preserved spermatogenesis and severe oligoasthenoteratozoospermia, and endocrine profiles are usually normal. Advances in imaging have enabled conservative, fertility‑preserving management in many patients, but the absence of prospective registries, standardized follow‑up protocols, and molecular profiling limits reliable risk stratification. Multicenter collaborations are therefore essential to refine oncologic estimates, clarify reproductive implications, and establish evidence‑based guidelines for this exceptionally rare condition.

Liquid embolic agents (LEAs) have expanded the therapeutic options for complex vascular and non-vascular conditions. Tailored clinical assessment with dedicated procedure planning is critical in the selection of the most appropriate embolic to ensure procedural success and minimise complications. The LEAs, which range from sclerosant agents to glues and copolymers all have specific physical characteristics. Sclerosant agents are mainly selected for symptomatic vein diseases such as varicoceles and low-flow venous and lymphatic malformations (VM and LM), usually requiring multiple treatment sessions to achieve a satisfactory response. Glues and copolymers have completely different properties but may have overlapping indications ranging from haemorrhage control (gastrointestinal and solid-organ), treatment of visceral and renal aneurysms or pseudoaneurysms to type II endoleaks, arteriovenous malformations/fistulas, tumour devascularisation, and selective end-organ embolisation. The use of each agent varies according to the specific clinical scenario, and operator experience and preference. This review aims to provide a concise and practical overview of the use of LEAs.

Male infertility presents significant heterogeneity, yet traditional assessments primarily rely on semen parameters and endocrine, imaging, and genetic screening. Although these methods can identify some definitive etiologies, a mechanistic explanatory gap persists in large populations with mild to moderate oligoasthenoteratozoospermia, elevated sperm DNA fragmentation, or recurrent adverse reproductive outcomes. The testis maintains a dynamic immune-privileged balance by balancing infection defense against tolerance to post-pubertal germ cell antigens. In this context, infections, varicocele-induced hypoxia or thermal stress, metabolic abnormalities, and environmental factors, trigger innate immune recognition via PAMPs or DAMPs. Notably, most mechanistic insights discussed are derived from animal models and in vitro studies; direct high-level clinical evidence in humans remains limited, and the proposed framework requires prospective validation. This is proposed to drive myeloid amplification, complement cascades, and inflammasome activation, which may in turn mutually reinforce oxidative stress. Based on current evidence, this may consequently compromise blood-testis barrier integrity, cause immune tolerance thresholds to decline, and induce tissue remodeling, collectively impairing the spermatogenic microenvironment, sperm maturation, and DNA integrity. This article reviews these immunological mechanisms and proposes a hypothesis-driven intervention framework driven by immune endophenotypes, aiming to provide an actionable clinical roadmap for the precision management of male infertility.

Varicocele has a substantial adverse effect on sperm production and male fertility, so varicocelectomy has an important role in treating infertility. Beyond its effects on fertility, varicocele may also be associated with pain, affect testosterone production and have some relevance for men with the most severe forms of male infertility, non-obstructive azoospermia. The adolescent with varicocele may also benefit from repair, especially if testicular growth has been affected. This issue of Fertility & Sterility has important insights into these clinical scenarios where varicoceles and their repair may be important.

Nutcracker syndrome (NCS) refers to symptomatic compression of the left renal vein (LRV), most commonly between the aorta and superior mesenteric artery (anterior nutcracker) or, less frequently, between the aorta and vertebral column in the presence of a retro-aortic LRV (posterior nutcracker). This venous entrapment elevates renal venous pressure and promotes drainage through the gonadal and pelvic venous networks. Clinical manifestations typically include haematuria, left flank or abdominal pain, orthostatic proteinuria, and features of gonadal or pelvic venous congestion such as varicocele. Diagnosis relies on careful clinical evaluation, exclusion of alternative aetiologies, and targeted imaging modalities including Doppler ultrasonography, computed tomography, magnetic resonance angiography, venography, and intravascular ultrasound. Despite increasing recognition of NCS, standardized diagnostic criteria and imaging thresholds remain lacking. Management strategies range from conservative treatment to endovascular interventions and open or laparoscopic surgical procedures. Optimal care requires a multidisciplinary approach involving urology, radiology, nephrology, and vascular surgery to ensure accurate diagnosis and individualized treatment planning.