Varicocele | Western Sydney University

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

375

Pages:

4
Author:

Mariam A. A.

Varicocele Definition Abnormal enlargement and tortuosity of the pampiniform plexus in the scrotum – bag of worms Epidemiology 90% on the left Causes Idiopathic/primary Symptomatic/secondary Mass in the retroperitoneal space Dysfunctional or incompetent valves within spermatic veins Ormond disease Longer left spermatic vein Lymphoma inserts at 90 degrees into the L renal vein Renal cell carcinoma slower drainage Obstruct IVC increased hydrostatic pressure right sided varicocele L vein passes between aorta and SMA Left renal vein increased risk for renal vein compression (nutcracker phenomenon) left sided varicocele Thrombotic event e.g. pampiniform plexus obstruction in increased intravascular P in left spermatic vein RRC varicocele formation Persist in supine position due to a physical obduction to BF within the spermatic vein Clinical Features History Physical Exam Negative transillumination Painless palpable scrotal enlargement Increases in size when standing or Valsalva manoeuvre or standing Symptoms worsen when standing or in Valsalva maneuverer Most common Dull and aching pain Soft bads or strands palpable in the upper pole of the affected scrotum – bag of worms Scrota heaviness Testicular atrophy Dragging sensation Infertility Positional relief – when lying down Red Flags Acute onset Right sides Persistent when lying flat Classifications Investigations Testosterone blood tests Semen analysis Scrotal U/S Dilation more than 2 mm Hypoechoic pampiniform vessels Doppler U/S Assess vein dilation and reflux during Valsalva manoeuvre Abdominal imaging When a secondary cause is suspected New onset or nonreducible varicocele Management Conservative Most resolve spontaneously Symptomatic treatment – scrotal support Surgical Indications Infertility Pain Significant testicular volume discrepancy or delayed growth in adolescents Procedures Varicocelectomy Surgical ligation of dilated testicular veins relieves venous congestion redirects BF Percutaneous embolization Complications Testicular atrophy Infertility Most common Increases testicular temperature impairs sperm production, motility and morphology Toxin reflux Hypoxia Chronic pain Stunted growth in adolescents Reduced testosterone production Prognosis Good as 80% of away on their own