Varicocele

Question 1

What is a varicocele?

Answer 1

dilated veins of the pampiniform plexus (which drain blood from the testis) forming a scrotal mass.

Question 2

Describe the aetiology of varicoceles

Answer 2

Due to venous incompetence (sort of like varicose veins)
LEFT > R (80-90%) because of:
Angle at which the left testicular vein meets the left renal vein
Lack of effective valves between left testicular vein + left renal vein
Increased reflux from compression of the renal vein (between SMA + the aorta): increased hydrostatic pressure in the vein
10% are bilateral

Question 3

Describe the aetiology of right sided varicoceles

Answer 3

RARE

May be caused by abdo or retroperitoneal compressive mass

Question 4

Describe the epidemiology of varicoceles

Answer 4

Unusual in boys < 10 yrs old
Incidence increases after puberty
Incidence: 15% in general population
Associated with infertility

Question 5

List 3 symptoms of a varicocele

Answer 5

Scrotum feels like a bag of worms
Scrotal heaviness
May feel dull ache (uncommonly can cause scrotal or groin pain)

Question 6

Describe symptoms of a varicocele

Answer 6

Usually ASYMPATOMATIC
Only 2-10% have symptoms
May be Incidental finding at examination

Question 7

List 4 signs of varicocele

Answer 7

Often visible as distended scrotal blood vessels (STANDING)
Side with varicocoele will hang lower
Swelling may reduce when lying down
Valsalva manouevre whilst standing will increase dilatation
Cough impulse

Question 8

How are varicoceles diagnosed?

Answer 8

CLINICAL DIAGNOSIS

Question 9

What investigations may be considered for patients presenting with a varicocele?

Answer 9

Sperm count: as part of fertility ix
Colour Doppler scan: used in men with a difficult exam e.g. small scrotum or due to obesity
FSH + Testosterone levels (uncommon cause of decreased testosterone)
CT + MRI abdo if retroperitoneal or abdo mass suspected