Varicocele, Hydrocele

Question 1

Define/causes of varicocele?

Answer 1

Enlargement of the veins (in the pampiniform plexus) within the scrotum.

Occurs due to faulty valves within the spermatic cord veins, causing blood to pool and enlarge these veins.

Question 2

Presentation of varicocele?

Answer 2

May be asymptomatic

“Bag of worms”
Aching or heavy feeling in the scrotum.
Testicular atrophy
Impaired fertility

Question 3

Diagnosis/IVx of varicocele?

Answer 3

Physical examination

Doppler US (identify enlarged veins and assess for retrograde blood flow) -CONFIRMS DIAGNOSIS

Hormonal assays (if infertility suspected; testosterone, FSH, LH and semen analysis)

Question 4

Management of varicocele?

Answer 4

Watchful waiting
- asymptomatic varicoceles
- no infertility problem

Embolisation:
- blocks blood flow to enlarged veins

Surgery:
- varicocele repair surgery

Question 5

Define/cause of hydrocele?

Answer 5

Accumulation of serous fluid in a sac-like cavity (within tunica vaginalis) specifically around the testicle.

The processus vaginalis should typically obliterate after the descent. If it doesn’t close completely, fluid from the abdomen can gradually accumulate in the scrotum, causing a hydrocele.

Question 6

Presentation of hydrocele?

Answer 6

Scrotal swelling, painless, and discomfort.

Can be unilateral or bilateral.

Rare -pain or redness in the scrotum (sign of infection or other conditions like testicular torsion or epididymitis).

Question 7

Diagnosis/IVx of hydrocele?

Answer 7

US (show fluid accumulation around the testicle)

Question 8

Management of hydrocele?

Answer 8

Most primary hydroceles (infants) resolves by itself within 12months of age.

Surgical correction
- if hydrocele persists >1year

Secondary hydroceles
- managed conservatively
- self-resolves