Varicocele is dilatation and tortuosity of the veins within the scrotum that drain blood from the testicles. It is more common on the left side where the left testicular vein drains directly into the left renal vein. Varicocele can cause increased temperature in the scrotum and impair sperm production. Treatment involves surgical ligation of the affected veins to repair blood flow and potentially improve fertility.

1. en love da Homoeopathy
VARICOCELE

2. VARICOCELE

3. VARICOCELE
• It is dilatation and tortuosity
of thepampiniform plexus
of veins and so also the
testicular veins.
Normally, there will be
numerous plexus of veins
(pampiniform) in the scrotum,
↓
whichall join together to form
about 4–8 veins in the inguinal
canal.

4. ↓
Above, in the abdominal cavity,
↓
in the posterior abdominal wall
↓
all join to forma single
testicular vein.
↓
On left side, it drains the left
renal vein
↓
on the right side it drains the
inferior vena cava.
INCIDENCE
• Varicocele is common in
tall, thinyoung men.
• More commonon the left
side, but oftencan be
bilateral.
FEATURES
• Commonly, it is idiopathic
in origin,
• may be due to absence or
incompetent valveat the
junction of left testicular
vein and left renal vein
causing inefficient
drainage of blood.

5. • Other reasonis, due to
perpendicular (right angle)
entryof the left testicular
veinintothe left renal vein.
• In left-sidedrenal cell
carcinoma, tumour
proliferates intothe left renal
vein and blocks the entry of
left testicular veincausing
varicocele on left side which is
irreducible
• Varicocele causes increased
temperaturein thescrotum
whichdepresses the
spermatogenesis and so
causes infertility(correctable
infertility).

6. TYPES
• Primary/idiopathic
↓
No cause is found.
↓
Thereis incompetence of
valves of the testicular vein.
↓
It is commonon left side
↓
becauseleft testicular vein
joins left renal vein
perpendicularly
↓
and left side vein is longer and
liable to get compressed by
loadedsigmoid colon.
↓
Left renal vein is often
compressed betweenaortaand
SMA.

7. • Secondary
↓
due to specific cause likeleft-
sided renal cell carcinoma
↓
with a tumour thrombus in left
renal vein
↓
causing obstruction to venous
flow of left testicular vein.
CLINICALFEATURES
• Bow sign
• After holding the varicocele
betweenthumband fingers
↓
patient is asked to bow.
↓
Varicocele gets reduced in size.
↓
Bowing reduces the blood flow of
testicular vein and pampiniform
plexus

8. ↓
causing reduction in size.
↓
Grading of varicocele
I. Small
II. Moderate
III. Large
IV. Severely tortuous.
DIFFERENTIAL DIAGNOSIS
• Hydrocele.
• Inguinal hernia.
• Lymph varix.
• Lipoma of the cord.
INVESTIGATION
• Venous Doppler of the
scrotumand groin.
• Ultrasoundabdomento look
for kidneytumour.
• Semenanalysis

9. TREATMENT
• Palomo’s operation:
• Suprainguinal
extraperitoneal
ligation of the
testicular vein.
• Inguinal approach
(Ivanissevichapproach):
Easier and safer.
• Subinguinalapproach
• Scrotal approach: In case of
grade IV, veins haveto be
excised throughthis
approach.
• Laparoscopic approach
INDICATIONS OF SURGERY™
• Pain™
• Oligospermia—usually in
6–12 weeks oligospermia
improves verywell and also
the conception rate
COMPLICATION
• Haemorrhage
• scrotal haematoma ™
• Infection
• pyocele ™
• Injury to testicular artery ™
• Injury to ilioinguinal nerve
and pain.

10. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

11. A
Special Thanks
To A Very
Special Doctor