Varicocele

Background

• Varicocele is a dilation and tortuosity of the internal spermatic veins within the pampiniform plexus
• Varicocele is a cause of decreased testicular function (causes infertility as it interferes with testicular thermoregulation)
• Common location is usually on left side (due to increased resistance from left gonadal vein draining into left renal vein)
• It is classified into primary (venous reflux) or secondary (renal cell carcinoma causing compression to the veins)

Clinical features

• Varicocele are mainly asymptomatic
• Primary symptoms include; dull ache in scrotum or feeling of heaviness in the scrotum
• It can present as a case of male infertility
• Physical examination includes negative illumination test (scrotum does not transilluminate)
• It is usually described as “bag of worms” on palpation

Diagnosis

• Ultrasound with Doppler
  

Treatment

• Conservative (monitor with annual exams in asymptomatic patients and no testicular hypotrophy)
• Surgical ligation or embolization (in cases of pain, infertility, or delayed growth of testes)

Complications

• Infertility
• Testicular atrophy

Differential diagnosis

Supplementary tables