Varicocele Flashcards
Define Varicocele
A varicocoele is an abnormal dilatation of the pampiniform venous plexus within the spermatic cord
veins become swollen
Varicocele clincial examination findings
- A scrotal mass that feels like a “bag of worms”
- More prominent on standing
- Disappears when lying down
Varicocele Sx
- Throbbing/dull pain or discomfort, worse on standing
- A dragging sensation
- Sub-fertility or infertility
Varicocele pathophysiology
increased resistance in the testicular vein. Incompetent valves in the testicular vein allow blood to flow back from the testicular vein into the pampiniform plexus.
Varicocele complications
- infertility
- testicular atrophy
where do the L testicular vein drain into
L renal vein
where do the R testicualar vein drain into
Inferior Vena Cava
Which side of the testicles do varicocele most common occur
L varicocele
why is L sided varicocele more likely to occur
Increase resistance from the L testicular vein (draining into L renal vein)
what can a L varicocele indicate
An obstruction of the L testicular vein –> Renal cell carcinoma
what examination should you perform on a pt with a varicocele
Abdo examination - to exclude Renal tumour
Varicocele Mx
- endovascular embolisation
- ligation of the spermatic veins
indicated for pain / atrophy / infertility
Varicocele RED flags
acute onset, right-sided, or remain when lying flat
Varicocele Ix
- Ultrasound with Doppler imaging can be used to confirm the diagnosis
- Semen analysis if there are concerns about fertility
- Hormonal tests (e.g., FSH and testosterone) if there are concerns about function
