Varicocoele
Aeitology
- Dilated tortuous "varicose" veins in pampiniform plexus (which drain testis)
- Occur in up to 15% of men, often around puberty
- Sudden appearance in old men - underlying peritoneal disease incl renal cell carcinoma extenind into the left renal vein
- 98% left sided
- connects to left renal vein
- Left renal vein can be compressed by colon, kidney tumours
- Left renal vein frequently lacks a terminal valve which serves to try to prevent back-flow in the vein
Approach
- As for scrotal examination
- Inspect
- Usually appears normal
- Palpate
- Varicocoele does not usually appear until patient is standing up - all scrotal examinations should include an examination of patient standing to exclude a varicocoele
- "Bag of worms"
- Non-transilluminable
- Distinct from superficial ring (can get above mass)
- May have palpable cough impulse
- Percuss
- Auscultate
Completion
- Examine contralateral hemiscrotum
Treatment options
- Non-surgical
- Transfermoal radiological embolisation of testicular vein (spirng coil or sclerosant)
- Surgical
- Palomo operation - exposure of testicular artery by high retroperitoneal approach through incision above and medial to anterior superior iliac spine and ligation of all surrounding veins
- Inguinal approach - with ligation of veins in the inguinal canal
- Laproscopic ligation
