Dilatation and tortuosity of pampiniform
plexus of veins.
Appear after puberty in most cases
98% are present on left because:
Left testicular vein is straighter, is
crossed and compressed by pelvic colon, longer than on the
right, terminal venous valve is frequently absent.
Suspicious varicocele: present on right,
appearing suddenly in middle-aged man, failing to empty on
lying flat – suggests a renal cell carcinoma invading left
renal vein or retroperitoneal cancer.
Associated with infertility – poor sperm
count quality and motility due to increased pressure,
temperature, hypoxia from retrograde blood flow or toxic
metabolites.
Indication for surgical treatment:
Pain or discomfort in scrotum
Infertility
What are the surgical options for varicocele
treatement
Surgical – ligation in scrotum, inguinal
canal or retroperitoneal. Laparscopic ligation
Non-surgical – embolization
Ligation of varicocele
Supine. Shave area in operating room. Time
out. Sterile prep and drape. I perform under GA. No IV Abx are
required.
Incision as for inguinal hernia. Open
external oblique aponeurosis, mobilize the cord and split the
cremasteric fascia longitudinally.
Separate the veins from the vas and
testiclar artery and ligate all enlarged veins with 2/0 Vicryl
ties.
Repair the external oblique aponeurosis
Complications:
oEarly: bleeding,
infection, the veins in the scrotum become hard until the
thrombosis organised, acute hydrocele, damage to the
ilio-inguinal nerve.