Varicocoele

Question 1

Define Varicocoele

Answer 1

Abnormal dilation of internal spermatic vessels/testes veins-

Question 2

Aetiology and risk factors of Varicocoele

Answer 2

90% happen in the left testes, 10% in both, mega rare in right alone
can happen in 15% of adolescent
most common cause seems to be genetic-abnormal valves
Left internal spermatic vein can also occasionally be longer and connect to renal vein-cause varicocele
also nutcracker phenomenon-where superior mesenteric artery presses on renal artery
also occasionally massive abdominal masses
or renal cell carcnimona-

has consequences on fertility and proper tests development (80% not associated with infertility)

Risk factors:
Males
FHx
tall/low BMI

Question 3

Epidiemology and risk factors

Answer 3

about 10-15% of adolescents and adults

80% are not associated with infertility,
but about 1/4 men with weird sperms have it
up to 80% of men with secondary infertility have it
surgical correction can help

Question 4

Signs and Sx of Varicocoele

Answer 4

Usually found on routine exams, or pt presents with painless scrotal mass
adult PC is mainly infertility (why examine when infertile)

90% are in the left teste

examination-
left side-
small testes
painless (3% do have pain)

patient-standing-moderate or large appear or are palpable-bag of worms
valsava manœuvres makes small ones come out
should drain when supine

make sure its not a hernia

any right sided/not draining when supine-worry

diagnosis if clinical

Question 5

Investigations of Varicocoele

Answer 5

Clinical diagnosis-
but can warrant a kidney USS because it can be associated with Renal Cell carcnima

a doppler can identify Varicocoele, but should be needed