Varicocele

INTRODUCTION:
  • It is seen 95% of times on left side.
  • Several anatomic features contribute to the predominance of left-sided varicoceles.
  1. The left internal spermatic vein is longer than the right; in addition, it usually joins the left renal vein at right angles.
  2. The right internal spermatic vein has a more oblique insertion into the inferior vena cava.
  3. This particular anatomy in the standing man may cause higher venous pressures to be transmitted to the left scrotal veins and result in retrograde reflux of blood into the pampiniform plexus.
CLINICAL FEATURE:
  • Age - young adult
  • Tall thin men are frequently affected
  • Bag of worms like feel on palpation
  • The veins empty in supine position (so examination is always done in standing position)
  • Varicocele of pampiniform plexus of veins has Negative transillumination test, is Reducible, shows Cough impluse
  • varicocele Can present as a late sign of renal cell carcinoma
  • Hypernephroma May present with rapidly developing varicocele
  • Infertility : The varicocele is the most common cause of male infertility world wide. In approximately 70% of patients with secondary infertility, a varicocele is an underlying cause.
  • Incompetent valves of testicular vein are responsible for varicocele
  • Variocele formation has been attributed to one of the three primary factors
  1. Increased venous pressure in left renal vein
  2. Collateral venous anastomoses
  3. Absent or incompetent valves in the internal spermatic vein.
TREATMENT:
  • Varicocelectomy, the surgical correction of a varicocele, is performed on an outpatient basis.
  • Indications of surgery in Varicocele are Small testis, Pain, Oligospermia The three most common approaches are inguinal (groin), retroperitoneal (abdominal), and infrainguinal/subinguinal (below the groin).
  • Drainage of venous blood from testes following division of testicular vein for treatment of varicocele is by Cremasteric vein
  • Possible complications of this procedure include hematoma (bleeding into tissues), infection, or injury to the scrotal tissue or structures.
  • In addition, injury to the artery that supplies the testicle may occur.
  • An alternative to surgery is embolization, a non-invasive treatment for varicocele.
  • Embolization is an effective treatment for post-surgical varicoceles.
  • Femoral catheterization with spermatic vein ablation is done in recurrence
Exam Question of:
  • varicocele Can present as a late sign of renal cell carcinoma
  • varicocele Has bag of worm like feeling
  • varicocele Can lead to infertility
  • Hypernephroma May present with rapidly developing varicocele
  • Varicocele is common on left testis because Left tesicular vein drains into left renal vein which has high pressure
  • Indications of surgery in Varicocele are Small testis, Pain, Oligospermia
  • Varicocele of pampiniform plexus of veins has Negative transillumination test, is Reducible, shows Cough impluse
  • Incompetent valves of testicular vein are responsible for varicocele
  • Femoral catheterization with spermatic vein ablation is done in recurrence
  • Drainage of venous blood from testes following division of testicular vein for treatment of varicocele is by Cremasteric vein

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