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What is Varicocele and How It Is Managed?

Varicocele means dilatation and elongation with tortuosity of the veins of the spermatic cord.

What is the definition of Varicocele?






Varicocele means dilatation and elongation with tortuosity of the veins of the spermatic cord.


Prevalence of varicocele
Prevalence of varicocele

Explain the surgical anatomy of veins of spermatic cord?

The veins of spermatic cord include
  • Veins of testis and epididymis
  • Veins accomapnying vas deferens
  • Veins of cremasteric muscle
Surgical Anatomy of Varicocele
Surgical Anatomy of Varicocele
These veins are 
  • 15-20 in number at the level of testis and epididymis
  • 4-8 veins at inguinal canal
  • 2 veins at the level of deep ring
Surgical Anatomy of Varicocele
Surgical Anatomy of Varicocele

What is the most common side of occurrence of varicocele and why?

Varicocele is seen 95% of times on the left side. This is because, left testicular vein draws into the left renal vein at right angles which creates high pressure on the left testicular veins


Left Testicular Vein
Left Testicular Vein

What are various characteristic features on clinical examination of varicocele?

  • The swelling may disappear on making the patient lie down
  • Varicocele feels like a bag of worms on palpation
  • Thrill like impulse is felt on coughing
Varicocele in a 15 year old boy
Varicocele in a 15 year old boy

What is the condition which should be ruled out in cases on varicocele?

Varicocele may be secondary to renal cell carcinoma of the left kidney and hence it should be ruled out. In cases where a renal cell tumour is a cause, varcocele does not decompress on supine position

What are the complications of untreated varicocele?

Infertility in cases of bilateral varicocele and long standing disease
Complications of Varicocele
Complications of Varicocele

Explain the grading of varicocele?

Grade 1: Palpable only during valsalva manuvre
Grade 2: Palpable at rest but not visible
Grade 3: Visible and palpable at rest
Usually grade 2 & 3 may lead to infertility and decreased testicular volume and hence need surgery

What are the various approaches to management of varicose veins?

Surgical ligation through various approaches 
  • Inguinal approach
  • Subinguinal approach
  • Retroperitoneal approach (Palomo operation)
  • Laparoscopic Varicocelectomy
Interventional Radiology - Embolisation of testicular vein

What are various indications for surgical intervention in varicocele?

Indications for surgical intervention in varicocele
Indications for surgical intervention in varicocele
     
Indications for surgical intervention in varicocele
Indications for surgical intervention in varicocele




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