Varicocele


Introduction

varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum.

  • Always left sided but 50% bilateral

Aetiology

Anatomical causes:

  • Geometry of the veins (left testicular vein & renal vein)
  • Valvular defect (venous insufficiency)
  • Nutcracker syndrome

Clinical features

Onset in adolescents 10-19 years old

  • ASYMPTOMATIC
  • SYMPTOMATIC
    • Soft lumps, usually above the testicle and mostly on the left side of the scrotum
    • Scrotal pain & heaviness (rare)
453px-varikozele2
Varicocele on the persons left | By User:Fisch12 – https://ca.wikipedia.org/wiki/Fitxer:Varikozele.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=58396609

Complication

  • Reduced testicular growth
  • ↓ Testosterone → ↓ Muscle strength & sexual function
  • Infertility

Diagnosis

Clinical examination:

  • Painless compressible mass over testicle
    • “Bag of worm” appearance
https://www.youtube.com/watch?v=bKMiQrVEjmo

Imaging:

  • USG
Trans_varicocele
Varicocele and testis in ultrasound (transverse image) | By Schomynv – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17253884

Grading:

  • Grade I: Only felt with straining
  • Grade II: Felt without straining
  • Grade III: Visible through skin

Differential diagnosis:

Dr. María Arqué (medical director at fertty international), Zaira Salvador BSc, MSc (embryologist) and Romina Packan (invitra staff). | (2020). Testicular Disorders & Infertility – Impact on Reproductive Function. Retrieved 23 April 2021, from https://www.invitra.com/en/male-sterility-because-of-testicular-failure/

Management

Surgical management:

20% reduction in testicular size in affected side and/or presence of complications indicates surgical treatment
  • Observation
  • Surgery:
    • Open surgery (preferred)
      • Inguinal/subinguinal varicocelectomy
    • Retroperitoneal laparoscopic surgery

Complications

  • Infection/abscess (1%)
  • Hydrocele (3%)
  • Recurrence/persistence (7%)

Percutaneous management:

  • Percutaneous occlusion
  • Percutaneous embolization

Complications

  • Bleeding at puncture site
  • Mild infections/inflammation
  • Recurrence/persistence (10%)
  • Technical failure (10%)
  • Migration of occluding device (rare)
https://www.youtube.com/watch?v=d4_LnU43yzU


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