Varicocele

This is a condition of varicosities of the pampiniform plexus of veins draining the testis

More common in the left testis (90%) – Due to anatomical arrangement of the left testicular vein

Commonly occurs in adolescence and early adulthood


Causes Of Varicocele

  1. Anatomical arrangement of left testicular vein 
    • Left testicular vein drains at right angle to the left renal vein 
    • But right renal vein drains obliquely to the right renal vein 
  2. Incompetent or absence of valves at the junction between proximal testicular vein 
  3. Obstruction of the left testicular vein by a tumor or following nephrectomy 
  4. Idiopathic


Management Of Varicocele

Clinical features

  1. Maybe asymptomatic 
  2. Dragging pain the scrotum 
  3. Discomfort maybe felt more towards the end of the day 
 
Examination 
  • Inspection 
    1. Affected testis lies lower than usual (In erect posture)
  • Palpation 
    1. Scrotum feels like a bag of worms (In erect posture)
    2. When the patient lies down, veins become emptied by gravity and gives an opportunity to palpate the testis which is usually normal in size
    3. In chronic cases, the testis can become smaller in size due to atrophy
 
Investigations
  1. Ultrasonography of the testis 
 
Treatment
  1. If the patient is asymptomatic 
    • No interventions are required
    • Only reassurance of the patient 
  2. If the patient is symptomatic
    1. For aching and discomfort due to weight of the varicocele – Close fitting undergarments 
    2. Embolization of the left testicular vein, radiologically 
    3. Surgical ligation of the testicular vein 
 
There is 20% chance of recurrence even after embolization 
 
 
Complications Of Varicocele
  1. Subfertility
  2. Atrophy of the testis
 
 
Testicular Venous Drainage

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1 year ago

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1 year ago

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