Varicocele is the abnormal dilation of the veins within the pampiniform venous plexus that drains the testes. It often presents as a bag of worms feeling in the scrotum and is a common cause of male infertility. Varicocele can cause issues like testicular atrophy and pain due to increased heat and ischemia within the testes. In Ayurveda, varicocele is understood as sanga (obstruction) of the shukra vaha srotas (channels carrying reproductive fluids), leading to klaibya (infertility). Treatment involves surgical ligation of the affected veins to relieve obstruction of the srotas.

1. TESTICULAR VARICOCELE AND ITS
EFFECTS ON MALE INFERTILITY
PRESENTER GUIDE
DR.Kiran.H.Gundagi DR.Prathibha.Kulkarni
1st Year PG Scholar Associate Professor &
HOD
DEPARTMENT OF SHAREERA KRIYA
Sri Dharmasthala Manjunatheshwara College of Ayurveda & Hospital
Hassan
15/5/2017

2. CONTENTS
• Introduction
• Anatomy of Pampiniform venous plexus
• Aetiology
• Clinical features
• Physical examination
• Grades
• Investigations
• Complications
• Treatment
• Discussion
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3. INTRODUCTION
• Testicular Varicocele is abnormal dilation and tortuosity of veins
of pampiniform venous plexus that drains the testis.
• Caused secondary to Internal spermatic vein reflux.
• Seen commonly in aged 15-30 years and rarely after 40yrs of
age,and it occur commonly on the left side of scrotum.
• Varicocele often described as feeling like bag of worms in
scrotum.
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4. Anatomy of Pampiniform venous plexus
• The pampiniform plexus is a
network of many small veins found
in the human spermatic cord.
• It is formed by the union of
multiple spermatic veins from the
back of the testis and tributaries
from the epididymis.
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5. Aetiology
• Dysfunction of valves
• Raised temperature
• Increased hydrostatic pressure
• Idiopathic causes
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6. PATHOPHYSIOLOGY
6
Impairment
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7. Clinical Features
• Painless lump
• Twisted veins in scrotum, which are often described as looking like
a bag of worms
• Dragging pain if testis is unsupported or after long standing.
• The scrotum on the affected side hangs lower than normal.
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9. Physical examination
9
• Performing the valsalva maneuver
while standing increases the dilation of
effected testis
• In long standing cases the effected
testis is smaller and softer and owing
to a minor degree of atrophy.
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10. INVESTIGATIONS
• Scrotal ultrasound
• Color Doppler
• Venograaphy
• C T Scan
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11. Grades of Varicocele
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Grade I Palpable during Valsulva Maneuver.
Grade II Palpable without Valsulva in standing
position.
Grade III Visible through scrotal skin.
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12. Varicocele:Predilection for the left side
• Left Testicular vein drains into the left renal vein at right
angle.
• Right testicular vein opens into the inferior venacava
obliquely
• The total length of left testicular vein is longer than the
right
• The loaded sigmoid colon may compress the left
testicular vein
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13. COMPLICATIONS
• Shrinkage of the affected testicle ( atrophy )
• Infertility
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14. Treatment
• Ligation of testicular vein above the inguinal ligament of
testicular vein where the pampiniform plexus has
coalesced into one or two vessles.
• Laproscopic
• Embolisation of the testicular vein
under the radiographic control
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15. Ayurvedic perspective
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16. SHUKRA VAHA SROTUS
MOOLA STHANA
शुक्रवहे द्वे, तयोर्मूलं स्तनौ वृषणौ च, तत्र ववद्धस्य
क्लीबता चचरात ् प्रसेको रक्तशुक्रता II
Su sa 9/12
16
शुक्रवहानां स्रोतसां वृषणौ र्मलं शेफश्च II
Ch vi 5/7
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17. NIDANA
• अततप्रवृवतिः सङ्गो वा ससराणां ग्रन्थयोपव वा|
ववर्ागूगर्नं चाव स्रोतसां दुष्टिलक्षणर््||
Ch vi 5/24
• अकालयोतनगर्नाष्न्नग्रहादततर्ैथुनात ्|
शुक्रवाहीतन दुटयष्न्त शस्त्रक्षाराष्ननससस्तथा II
Ch vi 5/19
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18. Shukravaha Sroto Dusti lakshana
• शुक्रस्य दोषात ् क्लैब्यर्हषूणर् ्|
रोचग वा क्लीबर्ल् ायुववूरू ं वा प्रजायते||
न चास्य जायते गसूिः ततत प्रस्रवत्यव |
शुक्रं हह दुटिं सा त्यं सदारं बाधते नरर् ्||
Ch Su 28/18-19
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19. DISCUSSION
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20. VARICOCELE AND INFERTILITY
Heat
– It has been observed that minor fluctuations in
the temperature can effect spermatogenesis.
Ischemia
– Due to varicocele the artery input to the testis is
hampered leading to hypoxia.
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21. Contd..
Obstruction to epidydimis
– Varicocele when very large may cause obstruction
to epidydimal duct there by impairing maturation
of spermatozoa.
 This condition (Varicocele) can be correlated as
Sanga of shukra vaha srotus leading to klaibhya.
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22. CONCLUSION
Varicocele is abnormal dilation and tortuosity of
veins of pampiniform venous plexus that drains
the testis.
Varicocele causes abnormality such as :-
1. Pain
2. Testicular discomfort and failure of testicular growth
and Infertility.
Obstruction caused by dialatation of veins can be
considered as sanga to shukra vaha srotus leading
to dusti hence klaibhya.
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23. Thank You
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