II. Epidemiology

  1. Present in 20% of all males
  2. Occurs in 30% of infertile men
    1. Most common correctable form of Male Infertility

III. Pathophysiology

  1. Abnormal venous tortuosity and dilatation
    1. Pampiniform venous plexus
    2. Internal spermatic vein
  2. Associated Infertility may be due to
    1. Elevated testicular Temperature
    2. Results in decreased spermatogenesis and motility

IV. Precautions: Red Flags

  1. Sudden onset Varicocele in older man
    1. Left: Assess renal tumor and spermatic vein Occlusion
    2. Right: Assess vena cava obstruction

V. Symptoms

  1. Often asymptomatic
  2. May cause mild pain with vigorous Exercise
  3. Patient finds mass lying posterior and above the Testes

VI. Signs

  1. "Bag of worms" superior to the Testicle
  2. Vein dilation and tortuosity
    1. Decreased with patient supine
    2. Increased with patient upright and with Valsalva Maneuver
  3. Left Varicocele most common (80% of cases)
    1. Left testicular vein drains into renal vein

VII. Management: Surgical repair

  1. Indication
    1. Abnormal Semen Analysis and Infertility
      1. Fails to Restore fertility by recent study
        1. Evers (2003) Lancet 361:1849-52 [PubMed]
    2. Persistant symptoms (Dull ache or heavy sensation)
  2. Procedures
    1. Surgical ligation of pampiniform plexus
    2. Injected sclerotherapy
    3. Directed embolization via Intervention Radiology

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Ontology: Varicocele (C0042341)

Definition (MSH) A condition characterized by the dilated tortuous veins of the SPERMATIC CORD with a marked left-sided predominance. Adverse effect on male fertility occurs when varicocele leads to an increased scrotal (and testicular) temperature and reduced testicular volume.
Concepts Disease or Syndrome (T047)
MSH D014646
ICD9 456.4
ICD10 I86.1
SnomedCT 155480003, 195480007, 51070004, 46871008
LNC LA14531-0
English Varicocele, Varicoceles, Varicocoele, varicocele (physical finding), varicocele, scrotal varices (diagnosis), scrotal varices, varicocele (diagnosis), scrotal varicocele (diagnosis), scrotal varicocele, Pampinocele, Scrotal varicose veins, Varicole, Varicocele [Disease/Finding], varicose veins scrotum, varicole, scrotum varicose vein, Varicose veins;scrotum, scrotal varicose veins, varicoles, varicoceles, scrotum varicose veins, Scrotal varices, Scrotal varices - varicocele, Scrotal varices (disorder), Varicocele (disorder), scrotum; varix, spermatic cord; varicocele, varices; scrotum, varicocele; spermatic cord, Varicocele [Ambiguous], varicocoele, varicose veins on the scrotum
Italian Vene dello scroto varicose, Pampinocele, Varici scrotali, Varicosi scrotale, Varicocele
Dutch scrotale varices, varicocele, scrotum; varix, varices; scrotum, varicokèle; zaadstreng, zaadstreng; varicokèle, balzak spataderen, varicokèle, Scrotale varices, Varicocele, Varicokèle
French Varices scrotales, Varices des veines scrotales, Varicocèle
German Pampinocele, Varicole, Skrotumvarizen, Varikozele
Portuguese Varizes escrotais, Varicocelo, Veias varicosas do escroto, Varicocele
Spanish Varices escrotales, Pampinocele, varicocele (trastorno), varicocele, várices escrotales (trastorno), várices escrotales, Venas varicosas escrotales, Varicocele
Japanese 陰嚢静脈瘤, 精索静脈瘤, セイサクジョウミャクリュウ, インノウジョウミャクリュウ
Swedish Pungåderbråck
Finnish Varikoseele
Czech Varikokéla, Pampinokéla, Skrotální varixy, Varikózní žíly skrota, varikokéla
Korean 음낭 정맥류
Polish Żylaki powrózka nasiennego
Hungarian Plexus pampinoformis sérve, scrotal varixok, Scrotalis varicosus venák, Varicosus, Varicocele
Norwegian Varikocele, Årebrokk i pungen