Varicocoele

Varicocoele is an enlarged and tortuous pampiniform plexus in scrotum due to obstruction of the spermatic vein. It's very common (15% of men).

Etiology

  • Idiopathic
  • Secondary to diseases which obstruct spermatic vein
    • Retroperitoneal mass
    • Thrombosis

Clinical features

  • Typically affects left side
  • Dull pain
  • “Bag of worms” appearance
  • Symptoms improve when lying down
    • Only in primary cases

Diagnosis

  • Clinical
  • Negative transillumination
  • Ultrasound

Treatment

  • Conservative
    • For most patients
    • Regular follow-up
    • Scrotal support
  • Surgical repair
    • Indications
      • Testicular atrophy
      • Infertility
    • Ligation of affected venous branches or percutaneous embolization

Complications

  • May increase the risk of infertility
  • Testicular atrophy