Varicocoele

Question 1

What is it?

Answer 1

An abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.

due to inadequate vlaves of the veins

Question 2

Aetiology?

Answer 2

More common on the LEFT (80-90%) because of:

The angle at which the left testicular vein meets the left renal vein
Lack of effective valves between the left testicular vein and left renal vein
Increased reflux from compression of the renal vein

Due to venous incompetence (sort of like varicose
veins)
10% are bilateral

Question 3

Epidemiology?

Answer 3

Unusual in boys under 10 yrs old

Incidence increases after puberty

Associated with infertility

Question 4

Presenting symptoms?

Answer 4

Usually ASYMPATOMATIC
Only 2-10% have symptoms

Scrotal mass
Scrotum feels like a bag of worms
Scrotal heaviness
small testicle - if growth arrest

Incidental finding at examination - ALot found when men presenting to fertility clinic; infertility

Question 5

Signs on examination?

Answer 5

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 whilst standing will increase dilatation

Cough impulse

Question 6

Investigations?

Answer 6

clinical diagnosis!

others;
scrotal US w/colour flow doppler
semen analysis - motility, count