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Figure 3 4.1 Endothelial dysfunction and vasoconstrictive imbalance Endothelial dysfunction represents a central pathological outcome through which systemic inflammatory signals may impair penile vascular homeostasis and contribute to ED ( In varicocele, circulating inflammatory mediators such as TNF-, IL-1, and IL-6 may act on endothelial cells and suppress eNOS expression or activity (114, 115)

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