Progress of the pathogenesis in varicocele: a narrative review

Varicocele (VC) is widely recognized as a prevalent and clinically significant cause of male infertility. However, the comprehensive pathogenic mechanisms underlying VC development and progression remain incompletely understood, creating an important knowledge gap in the field of andrology. This review establishes that VC pathogenesis centers on abnormal vascular remodeling and integrates multiple contributing elements, including anatomical abnormalities, biochemical disturbances, genetic factors, low body mass index (BMI), age, and specific sports habits, while secondary varicoceles are primarily induced by compressive pathologies. Through a systematic synthesis of current evidence and recent advances, this review aims to elucidate the complex pathogenic network of VC and provide valuable insights to guide future research directions and inform the development of targeted clinical applications.