Varicocele and Epididymitis

Question 1

What is a varicocele?

Answer 1

An abnormal dilation of a vein within the spermatic cord that normally drains blood from each testis.

Speculation it may be malfunction or absence of valve in vein to prevent backflow and pooling.

Most often appears on the left side d/t a difference in venous drainage.

Question 2

How does a varicocele cause male infertility?

Answer 2

Veins in the spermatic cord are meant to draw blood away from the testes. Pooling of blood can increase temperature, negatively affecting spermatogenesis.

Question 3

How do you physically detect a varicocele?

Answer 3

Soft mass (“bag of worms”) next to the testis when standing. Disappears in the recumbent position. Valsalva’s maneuver while standing helps to reveal a small vericocele.

When symptomatic, may cause scrotal pain which is typically dull, aching, or throbbing, usually left-sided, and noticeable when standing and relieved by recumbency.

Question 4

What is epididymitis?

Answer 4

Inflammation of the epididymis, a curved structure at the back of the testicle.

Question 5

What is the most common etiology of epdidymitis?

Answer 5

• Between 14-35: STI - likely N. gonorrhoeae or C. trachomatis.
• After 35 years of age, most common etiology is a UTI, involving Escherichia coli from GI tract.
• Enlarged prostate with age increases the risk
• In younger males not sexually active, usually d/t repetitive activity that causes mobility to scrotum or trauma
• infectious causes in young males may be d/t mumps infection or a UTI. UTI’s not common in young males unless anatomic abnormality.
• may occur following a vasectomy d/t engorgement of the epididymis with sperm or (less frequent) d/t infection

Question 6

Describe clinical findings of epididymitis.

Answer 6

1. unilateral pain
2. gradual onset
3. tenderness upon palpation of the testis along the posterior and superior areas