1. Varicocele
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3. Introduction
• Dilated, elongated & tortuous veins of the spermatic cord
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4. Veins of spermatic cord
• Veins draining the testis & epididymis
• Veins accompanying the vas deferens
• Veins of the cremasteric muscles
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5. Cross section showing the pampiniform plexus
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6. Varicocele: causes
• Idiopathic: 90% in the left side
• Tall, thin male
• Obstruction at the place of drainage
• Retroperitoneal fibrosis
• Renal cell carcinoma
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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
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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
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9. Varicocele: treatment
• Conservative
• Surgical
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10. Varicocele: conservative treatment
• Reassurance
• Scrotal support
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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
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12. Varicocele: surgical treatment
• Palomo operation
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14. Incision for an inguinal approach to varicocele
repair.
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