Varicocele

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Introduction

Dilated, elongated & tortuous veins of the spermatic cord

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Veins of spermatic cord

Veins draining the testis & epididymis

Veins accompanying the vas deferens
Veins of the cremasteric muscles

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Cross section showing the pampiniform plexus

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Varicocele: causes

Idiopathic: 90% in the left side

Tall, thin male
Obstruction at the place of drainage
Retroperitoneal fibrosis
Renal cell carcinoma

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Varicocele: predilection for the left side

The left testicular vein drains into the left renal vein at right angle whereas
the right testicular vein opens into the IVC obliquely
The total length of left testicular vein is longer than the right
In 15% of the cases the left testicular artery arches over the left renal vein
The loaded sigmoid colon may compress the left testicular vein
The left suprarenal vein drains into the left renal vein
Incompetent valves are more common in the left testicular vein
Occasionally the left renal vein may pass between abdominal aorta behind
& the superior mesenteric artery in front

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Varicocele: clinical features

Most are asymptomatic

If they do cause symptoms it is usually a vague or annoying discomfort

Examination shows the typical 'bag of worms'

Heavy sensation after walking or standing

Reduces in size in the supine position

Varicocele is occasionally associated with infertility

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Varicocele: treatment

Conservative

Surgical

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Varicocele: conservative treatment

Reassurance

Scrotal support

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Varicocele: surgical treatment

Varicoceles only need treatment if symptomatic

Veins can be ligated via either a scrotal or inguinal approach
Recent laparoscopic ligation has been reported
Recurrence can occur due to collateral supply via cremasteric vein

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Varicocele: surgical treatment

Palomo operation

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Incision for an inguinal approach to varicocele
repair.
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