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Varicocele

Varicocele is a varicose dilation of the veins that drain the testes, most commonly occurring on the left side. The veins form the pampiniform plexus around the testicular artery before draining into the renal vein. Varicoceles are often asymptomatic but can cause discomfort, swelling, and a bag-of-worms feeling in the scrotum. Diagnosis is made through ultrasound and treatment involves embolization or surgical ligation of the affected vein to redirect blood flow. Complications can include bleeding, infection, and injury to surrounding structures. Varicocele differs from hydrocele, hernia, lymph varix, and other scrotal masses.

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116 views19 pages

Varicocele

Varicocele is a varicose dilation of the veins that drain the testes, most commonly occurring on the left side. The veins form the pampiniform plexus around the testicular artery before draining into the renal vein. Varicoceles are often asymptomatic but can cause discomfort, swelling, and a bag-of-worms feeling in the scrotum. Diagnosis is made through ultrasound and treatment involves embolization or surgical ligation of the affected vein to redirect blood flow. Complications can include bleeding, infection, and injury to surrounding structures. Varicocele differs from hydrocele, hernia, lymph varix, and other scrotal masses.

Uploaded by

Mariam Antony
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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VARICOCELE

Jeffy James
Roll no-64
VENOUS DRAINAGE OF TESTIS
• Veins emerging from the testis form the
PAMPINIFORM PLEXUS
• Anterior part of plexus is arranged around
the testicular artery and the posterior part is
isolated
• Plexus condenses into 4 veins at the
superficial inguinal ring and into 2 veins
at the deep inguinal ring
• At last 1 vein is formed which drains into
inferior vena cava on the right side and into
left renal vein on the left side
ANATOMY
VARICOCELE

It is a varicose dilatation of the veins draining


the testes
AETIOLOGY
• Varicocele are common 15-20% males {tall, thin
young men}
• 90% are left sided
• In some cases the dilated vessels are cremasteric
veins and not part of pampiniform plexus
• Commonly it is idiopathic in orgin , due to absence or
incompetent valve at the junction of left testicular
vein and left renal vein causing inefficient drainage
• Sometimes it can be due to the obstruction of
the left testicular vein by a renal tumor (tumor
proliferates into the left renal vein and blocks
the entry of the left testicular vein in to the
left renal vein)
• This type of varicocele is irreducible
TYPES…
• Primary/idiopathic -95%: No cause is
found.There is incompetence of valves of the
testicular vein.It is common on left side
• Secondary- Due to specific cause like left sided
renal cell carcinoma with a tumour thrombus
in left renal vein
CLINICAL features.
• Most asymptomatic
• Those are symptomatic tend to present in
adolescence or early childhood as dragging
discomfort that is worse on standing at the end
of the day
• Swelling in the root of scrotum
• When examined in the erect position , scrotum
on the affected side hangs lower than normal
• Bag of worm appearance
• Impulse on coughing
• On lying down it gets reduced except in renal cell
carcinoma
• Long standing cases , the affected testis is smaller
and softer than its fellow owing to a minor degree of
atrophy
• Bow sign:After holding the varicocele between
thumb and fingers patient is asked to bow.Varicocele
get reduced in size.Bowing reduces the blood flow of
testicular vein and pampiniform plexus causing
reduction in size
INVESTIGATIONS
• Colour Doppler ultrasound
• (It is a reliable and non invasive method for the
evaluation of varicocele testes which allows the
detection of even subclinical varicocele . It
measures the size of pampiniform plexus and
blood flow parameters of spermatic veins)
• Ultrasound abdomen to look for kidney tumour
• Semen analysis
TREATMENT.
• Asymptomatic-no operation
• Embolization of testicular vein under
radiographic control is probably the treatment
of choice
• This helps to divert blood flow away from a
varicocele
• Laparoscopic ligation of the testicular vein
above the inguinal ligament where the
pampiniform plexus has coalesced into one or
two vessels
• Palomo’s operation; suprainguinal
extraperitoneal ligation of testicular vein
• Inguinal approach (Ivanissevich approach)
• Subinguinal approach(Marc-Goldstein
approach) ; subinguinal approach at
superficial inguinal ring outside the external
oblique apponeurosis without opening it
• Scrotal approach
COMPLICATIONS
• Haemorrhage and scrotal haematoma
• Infection,pyocele
• Injury to testicular artery
• Injury to ilioinguinal nerve and pain
• Recurrence
DIFFERENTIAL DIAGNOSIS
• HYDROCELE
• INGUINAL HERNIA
• LYMPH VARIX
• LIPOMA OF THE CORD
THANK YOU

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