- Varicocele
- Dilated, tortuous pampiniform plexus veins that surround spermatic cord
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Incidence increases after Puberty
- Not typically present in prepubertal boys
- Found in 15% of boys over age 15 years
- Present in 20% of all males
- Occurs in 35% of men with primary Infertility, and up to 80% with secondary Infertility
- Most common correctable form of Male Infertility
- Abnormal venous tortuosity and dilatation of the pampiniform venous plexus or internal spermatic vein
- Gonadal vein valve incompetence
- External compression of gonadal vein
- Associated Infertility may be due to
- Elevated testicular Temperature
- Results in decreased spermatogenesis and motility
- Right-sided Varicocele without a left-sided Varicocele
- Evaluate for retroperitoneal mass compressing right spermatic vein
- Sudden onset Varicocele in older man
- Left: Assess renal tumor and spermatic vein Occlusion
- Right: Assess vena cava obstruction
- Often asymptomatic
- May cause mild pain (dull ache or heaviness) exacerbated by standing or vigorous Exercise
- Patient finds mass lying posterior and above the Testes
- Perform exam with patient standing to increase Varicocele engorgement
- "Bag of worms" superior to the Testicle
- Vein dilation and tortuosity within the pampiniform plexus
- Decreased with patient supine
- Increased with patient upright and with Valsalva Maneuver
- Left Varicocele most common (80-90% of cases)
- Left spermatic vein drains into renal vein at a 90 degree angle
- Right spermatic vein drains into vena cava
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Scrotal Ultrasound
- Consider for diagnosis confirmation if unclear by exam
- Management
-
Surgical repair
- Indication
- Persistant symptoms (Dull ache or heavy Sensation)
- Abnormal Semen Analysis and Infertility
- Surgery may fail to Restore fertility
- Evers (2003) Lancet 361:1849-52 [PubMed]
- Persad (2021) Cochrane Database Syst Rev (4): CD000479 [PubMed]
- Procedures
- Surgical ligation of pampiniform plexus
- Injected sclerotherapy
- Directed embolization via Intervention Radiology
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