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