Varicocoele

Question 1

Define Varicocoele?

Answer 1

Dilated veins of the pampiniform plexus forming a scrotal mass

Question 2

What is the aetiology of Varicocoele?

Answer 2

More common on the LEFT (80-90%)

Due to venous incompetence (sort of like variose veins)

Question 3

Why are Varicocoeles more common on the left?

Answer 3

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 (between the superior mesenteric artery and the aorta)

Question 4

What is the epidemiology of Varicocoele?

Answer 4

Unusual in boys under 10 yrs old
Incidence increases after puberty
Incidence: 15% in general population
Associated with infertility

Question 5

What are the presenting symptoms of Varicocoele?

Answer 5

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

Question 6

What are the signs of Varicocoele on physical examination?

Answer 6

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 7

What investigations do you do for Varicocoele?

Answer 7

Sperm count - done as part of fertility investigation

Colour doppler scan