Varicocoele

Question 1

Define

Answer 1

dilated veins of the pampiniform plexus forming a scrotal mass

Question 2

Which side is more common and why?

Answer 2

• More common on the LEFT (80-90%) because of:
o The angle at which the left testicular vein meets the left renal vein (right angle)
o Lack of effective valves between the left testicular vein and left renal vein
o Increased reflux from compression of the renal vein (between the superior mesenteric artery and the aorta)

Question 3

What’s the cause?

Answer 3

• Anatomical features, namely increased hydrostatic pressure in the left renal vein and incompetent or congenitally absent valves

Question 4

What are the risk factors?

Answer 4

affected first-degree relatives (especially brothers) and certain somatometric parameters (tall/low BMI).

Question 5

What’s the epidemiology?

Answer 5

• Unusual in boys under 10 yrs old
• Incidence increases after puberty
• Occurs in 15% of adolescent boys and adult men; 90% of cases on left side; 10% are bilateral.
• Associated with infertility

Question 6

What are the presenting symptoms?

Answer 6

•	Usually ASYMPATOMATIC
o	Only 2-10% have symptoms 
•	Scrotum feels like a bag of worms
•	Scrotal heaviness 
•	Incidental finding at examination

Question 7

What are the signs?

Answer 7

• Patient must be STANDING for examination
• The side of the scrotum with the varicocoele will hang lower
• The swelling may reduce when lying down
• Valsalva manouevre (forced expiration while holding breath and pinching nose) whilst standing will increase dilatation
• Cough impulse

Question 8

What are the appropriate investigations?

Answer 8

CLINICAL DIAGNOSIS
• Sperm count - done as part of fertility investigation – variable, low sperm count
• scrotal ultrasound with colour flow Doppler imaging