- A varicocele consists of dilatation of veins draining the testis
- In the scrotum the veins form the pampiniform plexus
- Reduce to one or two veins in the inguinal ligament
- One testicular vein is formed at the deep inguinal ring
- Left testicular veins drains into the left renal vein
- Right testicular vein drains into the inferior vena cava
- Some venous drainage also occurs via cremasteric vein into the inferior epigastric veins
Clinical features
- Most varicocele are detected in adolescence or early adult life
- 95% occur on the left side and are idiopathic
- Occasionally associated with left renal tumours
- Most are asymptomatic
- If they do cause symptoms it is usually a vague or annoying discomfort
- Examination shows the typical 'bag of worms'
- Reduces in size in the supine position
- Varicoceles are occasionally associated with infertility
- But no evidence that surgery increased semen quality or conception rate
Management
- 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
Bibliography
Evers J L H, Collins J A. Assessment of efficacy of varicocele repair for mail
subfertility: a systematic review. Lancet 2003; 361: 1849-1852.
Skoog S J, Roberts K P, Goldstein M, Pryor J L. The adolescent varicocele: what's new with an old problem in
young patients? Pediatrics 1997; 100: 112-122. |