Section: Urology Curriculum: Curriculum, page 6

Definition

Dilated tortuous vessels from pampiniform plexus of spermatic cord and internal spermatic vessels

Incidence

Primary
- The idiopathic varicocele occurs when the valves within the veins along the spermatic cord do not work properly.
- This results in backflow of blood into the pampiniform venous plexus. Venous backflow increases vein diameter because of excessive pressure, and testosterone pooling.
Secondary
- Due to compression of the venous drainage of the testicle.
  - Pelvic or abdominal malignancy
- Nutcracker syndrome
- Renal cell carcinoma
- Retroperitoneal fibrosis or adhesions

80-90% left sided (drain into Renal Vein)
50% bilateral
Usually asymptomatic
Can cause dragging symptom in groin
Examine when standing, feels like bag of worms
Assess testicular size when examining
Clinically concerning
- Right sided
- Sudden appearance
- Fails to empty while lying flat (suggesting compression of left renal vein)

Hydrostatic pressure transmitted from testicular vein causing distension and tortuosity of pampiniform plexus

Indications
- Symptomatic
- Testicular growth retardation
- Concern re: Fertility (abnormal semen analysis)
Contraindication
- Do not operate simultaneously with vasectomy (delay 6 months to allow collateral vessels to develop)
Surgery
- Abnormal veins ligated while preserving vas + artery
- Microsurgical varicocelectomy
- Laparoscopic treatment of varicocele
- Inguinal approach of varicocele
Microscopic more accurate
Complications
- Hydrocele
- Injury to spermatic cord contents and the consequences - atrophy, infertility
- Recurrance
- Hematoma
- Wound infection