Varicocoele

Question 1

Define varicocoele

Answer 1

Dilated veins of the pampiniform plexus forming a scrotal mass

Question 2

Aetiology of varicocoele

1 + 4

Answer 2

Due to venous incompetence

More common on the LEFT (80-90%):
Angle the left testicular vein meets the left renal vein
Lack of effective valves between the left testicular vein & the left renal vein
Increased reflux from compression of renal vein

Question 3

Epidemiology of varicocoele

4

Answer 3

Unusual in boys under 10yrs old
Incidence increases after puberty
15% incidence in general population
Associated w/ infertility

Question 4

Presenting symptoms of varicocoele

general + 3

Answer 4

Usually ASYMPTOMATIC (only 2-10% have symptoms)

Scrotum feels like a bag of worms
Scrotal heaviness
Incidental finding at examination

Question 5

Signs of varicocoele on physical examination

general + 4

Answer 5

Patient must be STANDING for examination

Side of the scrotum w/ the varicocoele will hang lower
Swelling may reduce when lying down
Valsalva manoeuvre whilst standing will increase dilatation
Cough impulse

Question 6

Investigations for varicocoele

2

Answer 6

Sperm count - part of fertility investigation

Colour doppler scan