Varicocele

Aetiology and pathological features:

• The venous valve at the junction of the left spermatic vein with the renal vein is incompetent or becomes so
• It is most uncommon for the same to take place on the right
• Very occasionally, a tumour in the kidney with extension along the renal vein may be present
• Varicocele is a common finding in men presenting with subfertility but is equally common in men requesting vasectomy for contraception
• The veins of the pampiniform plexus become enlarged and tortuous

Clinical features:

There is a dragging sensation in the scrotum which is worse in hot weather and on prolonged standing

Subfertility may be mentioned

Physical examination reveals the ‘bag of worms’ which becomes more obvious if the patient stands

A cough impulse is present in the same position

The left testicle may be smaller than the right

Management:

• Treatment is required for those with symptoms and for those with subfertility
• The procedure of choice is embolisation of the testicular vein under radiological control