Varicocele

1. Varicocele

3. Introduction • Dilated, elongated & tortuous veins of the spermatic cord

4. Veins of spermatic cord • Veins draining the testis & epididymis • Veins accompanying the vas deferens • Veins of the cremasteric muscles

5. Cross section showing the pampiniform plexus

6. Varicocele: causes • Idiopathic: 90% in the left side • Tall, thin male • Obstruction at the place of drainage • Retroperitoneal fibrosis • Renal cell carcinoma

7. Varicocele: predilection for the left side • The left testicular vein drains into the left renal vein at right angle whereas the right testicular vein opens into the IVC obliquely • The total length of left testicular vein is longer than the right • In 15% of the cases the left testicular artery arches over the left renal vein • The loaded sigmoid colon may compress the left testicular vein • The left suprarenal vein drains into the left renal vein • Incompetent valves are more common in the left testicular vein • Occasionally the left renal vein may pass between abdominal aorta behind & the superior mesenteric artery in front

8. Varicocele: clinical features • Most are asymptomatic • If they do cause symptoms it is usually a vague or annoying discomfort • Examination shows the typical 'bag of worms' • Heavy sensation after walking or standing • Reduces in size in the supine position • Varicocele is occasionally associated with infertility

9. Varicocele: treatment • Conservative • Surgical

10. Varicocele: conservative treatment • Reassurance • Scrotal support

11. Varicocele: surgical treatment • 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

12. Varicocele: surgical treatment • Palomo operation

14. Incision for an inguinal approach to varicocele repair.