Varicocoele

Question 1

Define Varicocoele

Answer 1

The abnormal dilation of the veins in the internal spermatic veins and pampiniform plexus

Question 2

Where does the pampiniform plexus drain blood from?

Answer 2

The testes

Question 3

Which testes is more commonly associated with varicocoele? And why?

Answer 3

The left testes.

1. Because of the angle that it drains into the left renal vein.
2. Lack of effective valves between the left renal vein and the left testicular vein.
3. Increased reflex from compression of the renal vein by the SMA and aorta.

Question 4

What are the risk factors for varicocoele?

Answer 4

1. Tall men
2. Low BMI
3. Fhx
   All weak risk factors

Question 5

What is the epidemiology of varicocoele?

Answer 5

1. Less common in pre-puberty
2. Can be associated with infertility
3. 90% in left side

Question 6

What are the presenting symptoms of varicocoele?

Answer 6

Often asymptomatic and an incidental finding

1. Heavy scrotum
2. Scrotum feels like bag of worms

Question 7

What are the signs on physical examination of varicocoele?

Answer 7

1. Side affected will hang lower
2. Valsalva manouevre will increase dilation
3. Cough impulse

Question 8

What must you ask patients to do when examining them for varicocoele?

Answer 8

Patient must be standing.

Lying down will reduce swelling

Question 9

What are the appropriate investigations for varicocoele?

Answer 9

1. Semen analysis for infertility

2. Colour doppler scan of scrotum