Varicoceles (idiopathic or primary) are present in approximately 15% of adult men .
Patients with idiopathic varicocele usually present between the ages of 15 and 25 years.
A varicocele is an abnormal dilatation of the pampaniform veins is usually caused by incompetent valves in the internal spermatic vein.
This results in impaired drainage of blood into the spermatic cord veins when the patient assumes an upright position or during a Valsalva maneuver(42)
The veins of the pampiniform plexus normally range from 0.5 to1.5 mm in diameter, with the main draining vein being as large as 2 mm in diameter.
Varicoceles are more common the left side for the following reasons:
(a) The left testicular vein is longer;
(b) the left testicular vein enters the left renal vein at a right angle;
(c) the left testicular artery in some men arches over the left renal vein, thereby compressing it;
(d) the descending colon distended with feces may compress the left testicular vein .
Palpation reveals a scrotal mass that may feel like a bag of worms, with or without a palpable thrill.
Symptoms of varicocele may include:
- Dragging and aching pain in the scrotum.
- Feeling of heaviness in the testicle.
- Infertility.
- Shrinkage (atrophy) of the testicle.
- Visible or palpable (able to be felt) enlarged vein.
Diagnosis of palpable varicocele is important, because treatment improves sperm quality in as many as 53% of the cases.
The relationship between nonpalpable (subclinical) varicocele and infertility remains controversial.
USG FINDING IN VARICOCELE –
.US should be performed with the patient in both a supine and a standing position.
US appearance of varicocele consists of multiple, hypoechoic, serpiginous, and tubular structures of varying sizes larger than 2 mm in diameter that are usually best visualized superior and/or lateral to the testis.
When large, a varicocele can extend posteriorly and inferiorly to the testis. Occasionally, low-level internal echoes can be detected in the dilated veins, secondary to slow flow.
Color flow and duplex Doppler US optimized for low-flow velocities help confirm the venous flow pattern, with phasic variation and retrograde filling during aValsalva maneuver.
. The sensitivity and specificity of varicocele detection approaches 100% with color Doppler US.
Secondary varicoceles –
Mainly result from increased pressure on the spermatic vein produced by disease processes such as hydronephrosis, cirrhosis, or abdominal neoplasm.
Neoplasm is the most likely cause of non decompressible varicocele in men over 40 years of age; it is classically caused by a left renal malignancy invading the renal vein.
Noncompressible varicoceles on the left or right should prompt evaluation of there retroperitoneum to exclude retroperitoneal mass and of the left renal vein for thrombus or tumor extension.