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 
  • 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
  1. Ultrasonography of the testis 
  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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