Scrotal Disease: Varicocele Flashcards
Definition
Abnormal enlargement of the testicular veins within the pampiform plexus due to increased left renal vein pressure causing reflux
- bag of worms
- majority occur on the left side due to increased resistance
Epidemiology
15% of adolescent boys + mens
Unusual in boys under 10
Incidence increases after puberty
Risk factors
Tall + thin with lower BMI than aged matched controls
Family history (esp brothers)
Aetiology
Increased hydrostatic pressure in the left renal vein (which could be due to a malignancy)
Congenitally absent valves
Pathophysiology
Right testicular vein drains directly into IVC
Left ventricular vein drains directly into left renal vein
Left sided varicocele can indicate an obstruction of the left testicular vein caused by renal cell carcinoma
Anything that leads to increased pressure may cause varicoceles - incomplete valves allows blood to flow back from testicular vein into the pampiform plexus
Grading
Sub-clinical = no clinical abnormality only detected by Doppler USS
Grade I (small) = only palpable with Valsalva
Grade II (moderate) = palpable without Valsalva
Grade III (large) = Varicocele is visible through scrotal skin
Signs + Symptoms
Usually asymptomatic
Palpable scrotal veins
Maybe small testicle
Scrotum may hang lower on the side of the varicocele
- signs on testicular atrophy on affected side
May present with scrotal swelling pain
- reduced on lying down (if don’t concern for retroperitoneal tumour)
- exacerbated on Valsalva manoeuvre
Diagnosis
GOLD STANDARD: USS with doppler colour flow
Semen analysis
Serum FSH + testosterone
DDx
Cord hydrocele
Inguinal hernia
Spermatocele
Treatment
Uncomplicated = conservative treatment
Surgery or endovascular embolisation may be indicated for pain, testicular atrophy or infertility
Complication
Testicular atrophy
Infertility
Post surgical bowel injury
Post surgical hydrocele
