Variocele

Question 1

What is a variocele?

Answer 1

dilated veins of the pampiniform plexus forming a scrotal mass

Question 2

What are two causes of variocele?

Answer 2

1. Increased hydrostatic pressure in the left renal vein

2. Incompetent venous valves

Question 3

Where are variocele most common?

Answer 3

Most common in the left (80-90%)

Question 4

What is epi for variocele?

Answer 4

Increased incidence after puberty

Question 5

Why is a left variocele more common?

Answer 5

1. Left pampiniform plexus is subjected to increased hydrostatic pressures due to the perpendicular insertion of the vein into the left renal vein
2. The left internal spermatic vein is longer leads to increased hydrostatic pressure transmission

Question 6

What is the presentation of a variocele?

Answer 6

1. Asymptomatic

2. Bag of worms

Question 7

What investigations are done for a variocele?

Answer 7

1. Patient must be STANDING for examination
2. Fertility analysis
3. Retroperitoneal USS/CTAP

Question 8

Why must the patient be standing?

Answer 8

May reduce when lying down

Question 9

What is done in a fertility analysis?

Answer 9

Sperm count/semen analysis

Question 10

When do you do a Retroperitoneal USS/CTAP?

Answer 10

If does not diminish in supine (check if something is blocked)

Question 11

Why do you do a Retroperitoneal USS/CTAP?

Answer 11

if varicocoele does not diminish in supine position, to exclude abdo/retroperitoneal mass causing physical obstruction of testicular venous return

Question 12

What is the management of a variocele?

Answer 12

1. Reassurance + Observation

2. If semen analysis abnormal  surgical repair should be offered