urology,

Varicocele

Mar 20, 2020

Key facts

  • A varicocele is the abnormal dilation pampiniform plexus and the internal spermatic vein that drain blood from the testis.
  • Left side (90%)> Right side (10%)
  • Bilateral varicoceles may affect fertility

Aetiology

  • Mostly idiopathic
  • Left-sided renal tumour (which may invade the left renal vein and prevent drainage of blood)

History

  • Painless scrotal mass
  • Scrotum feels heavy
  • Family history of varicocele (especially brothers)
  • In some, features of renal cell carcinoma

Examination

  • Worm-like venous dilatation
  • Does not transilluminate (important to distinguish it from Hydrocele)
  • Small testicle on the affected side (due to testicular growth arrest)

Investigations

  • Usually by clinical features
  • USS if uncertain or difficult examination
  • Semen analysis and serum testosterone- men with subfertility and varicocele

Management

  • Adolescent:
    • Sub-clinical: reassurance
    • <20% size difference or symmetrical testes: observation
    • Asymetrical testes: Surgery
  • Adults
    • Usually conservative by observation
    • Surgery if symptomatic, or atrophic testes or, subfertility
      • Varicocelectomy, surgical ligation/embolisation of the affected vein