Varicocele Flashcards
def
abnormal dilation of the internal spermatic veins and pampniform plexus that drains the testis
AKA a mass of varicose veins in the spermatic cord
epi
common in adolescent boys and men
what is an initiating factor of Varicocele
puberty
risk factors
adolescent boys and men who are tall and heavy
FHx
aetiology
increased hydrostatic pressure in the left renal vein and incompetent/absent valves within the left internal spermatic vein are associated with Varicocele formation
risk factors
males who are tall and heavy
FHx
history
painless scrotal mass
most commonly on the left side, and rarely bilateral, but almost never on the right side
examination
commonly left sided non-tender scrotal mass small testicle (large varicoceles are associated with stopping testicular growth) men may complain of infertility (varioceles rarely cause infertility, however those with reduced fertility are more likely to have variocele)
investigations
generally a clinical diagnosis
scrotal USS with colour flow doppler is used in those with a small scrotum or with obesity
-used to identify presence of varicocele, very accurate method to measure testicular size and compare with the contralateral testis
why are varicoceles generally only found in the left testicle
the left internal spermatic vein inserts into the left renal vein at a right angle compared with the right internal spermatic vein which joins the IVC at an oblique angle
additionally the left internal spermatic vein is longer than the right internal spermatic vein
this leads to increased hydrostatic pressure in the left pampniform plexus of the left testicle
additionally incompetent valves in the left internal spermatic vein contribute to varicocele formation
a 15y/o boy presents with left scrotal swelling which is completely asymptomatic. No PMH and no previous surgeries, no DHx. O/E there is asymmetrical testicular size (left smaller than right)
varicocele
