Introduction:
Varicocele is dilatation of pampiniform plexus (testicular veins). Because of dilatation of veins there is increased temperature inside the scrotum which may cause testicular insufficiency leading to testicular atrophy and subsequent infertility.
In smaller children, varicocele may be caused by kidney tumors like Wilms' tumor, Neuroblastoma or hydronephrosis. The mass effect causes obstruction to the testicular venous return which opens into renal vein.
Clinical presentation:
1. Soft, painless, compressible swelling at the upper part of scrotum above testis.
2. This swelling gives characteristic 'Bag of worms' appearance.
3. Dragging sensation into scrotum.
Etiology:
1. Absence of valves in testicular veins.
2. Perpendicular entry of left testicular vein into high-pressure left renal venous system.
3. External pressure of loaded sigmoid colon on testicular vein.
4. Left adrenal veins also opens into left renal vein exactly opposite to the entry of left testicular vein. Because of adrenaline secreted by adrenal gland, there is spasm at the origin of vein.
Effects of Varicocele:
Testicular atrophy and subsequent infertility in adult life.
Investigations:
The indications for surgical treatment for varicocele are,
1. Chronic pain and discomfort
2. Sub-infertility in adults
3. Atrophy of the testis
4. 10% difference in volume of both testis measured by orchidometer
Surgical treatment:
1. Palomo's procedure:
Mass ligation of testicular vein and artery in the retro peritoneum above the internal ring.
2. Laparoscopic varicocelectomy
Complications:
1. Recurrence
2. Testicular atrophy
3. Nerve Injury
4. Injury to vas
5. Reactive hydrocele
