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Persistent venous hypertension and abnormal hemodynamics drive profound structural and cellular remodeling of the spermatic vein wall ( In vitro studies support these findings, showing that smooth muscle cells derived from varicose veins display marked dedifferentiation, enhanced proliferative and migratory capacity, increased matrix metalloproteinase-2 (MMP-2) production, and elevated collagen synthesis, accompanied by downregulation of contractile phenotype markers, collectively promoting extracellular matrix turnover and venous wall remodeling, thereby weakening mechanical resistance to chronic pressure ( 3.4 Secondary structural alterations and semen impairment in varicocele Progressive dilation of the pampiniform plexus and venous reflux in varicocele can induce structural and functional alterations in surrounding tissues
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