Varicocele

Question 1

What is a varicocele?

Answer 1

Where the veins in the pampiniform plexus become swollen (the venous network draining the testes and epidydimis)

Question 2

Which side are varicoceles more common on?

Answer 2

Left side

Question 3

Why are varicoceles more common on the left side?

Answer 3

The right testicular vein drains directly into the IVC, whereas the left testicular vein drains into the left renal vein

Question 4

What is the presentation of a varicocele?

Answer 4

Throbbing/dull pain
Pain worse on standing
Dragging sensation
Sub-fertility or infertility

Question 5

What are the findings of a varicocele on examination?

Answer 5

Scrotal mass that feels like a bag of worms
More prominent on standing
Disappears when lying down
Asymmetry in testicular size

Question 6

What investigations can be used in the diagnosis of a varicocele?

Answer 6

Ultrasound with doppler imaging - diagnostic
Semen analysis
Hormonal tests - FSH and testosterone

Question 7

What is the management of varicocele?

Answer 7

Most cases can be managed conservatively

Some cases may need surgery or endovascular embolisation