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