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4.4 Summary of the integrated testicular-penile pathological axis The mechanisms described above suggest that varicocele may contribute to ED through a multi-level testicularpenile pathological axis centered on inflammation, oxidative stress, vascular dysfunction, smooth muscle remodeling, and neural injury ( Within penile tissue, these systemic signals may induce three major pathological outcomes

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Bae JH, Han KD, Ko SH, et al