VARICOCELE
INTRODUCTION:
It is seen 95% of times on left side.
Several anatomic features contribute to the predominance of left-sided varicoceles.
The left internal spermatic vein is longer than the right; in addition, it usually joins the left renal vein at right angles.
The right internal spermatic vein has a more oblique insertion into the inferior vena cava.
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
Increased venous pressure in left renal vein
Collateral venous anastomoses
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