Varicocele
| Varicocele | |
|---|---|
 |
|
| Cross section showing the pampiniform venus plexus | |
| Pronunciation | /ˈværᵻkoʊˌsiːl, -kə-/ |
| Classification and external resources | |
| Specialty | Urology |
| ICD-10 | I86.1 |
| ICD-9-CM | 456.4 |
| DiseasesDB | 13731 |
| MedlinePlus | 001284 |
| eMedicine | radio/739 |
| Patient UK | Varicocele |
| MeSH | D014646 |
A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Upward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves, or compression of the vein by a nearby structure, can cause dilation of the testicular veins near the testis, leading to the formation of a varicocele. Causes of varicocele include valvular incompetence, Nutcracker syndrome, and renal cell carcinoma. Varicoceles occur in 20% of all men.
Symptoms of a varicocele may include:
The idiopathic varicocele occurs when the valves within the veins along the spermatic cord do not work properly. This results in backflow of blood into the pampiniform venous plexus. Venous backflow increases vein diameter because of excessive pressure, and testosterone pooling. Pooled blood is toxic and may cause damage to the testicles and veins. Varicoceles develop slowly and may not have any symptoms. They are most frequently diagnosed when a patient is 13–30 years of age. They occur in 20% of all males.
A majority of idiopathic varicoceles occur on the left side, because the left testicular vein travels superiorly and connects to the left renal vein (at a 90-degree angle), while the right testicular vein drains directly into the inferior vena cava. Isolated right sided varicoceles are rare.
A secondary varicocele is due to compression of the venous drainage of the testicle. A pelvic or abdominal malignancy is a definite concern when a unilateral right-sided varicocele is newly diagnosed in a patient older than 40 years of age. One non-malignant cause of a secondary varicocele is the so-called "Nutcracker syndrome", a condition in which the superior mesenteric artery compresses the left renal vein, causing increased pressures there to be transmitted retrograde into the left pampiniform plexus. The most common cause is renal cell carcinoma (a.k.a. hypernephroma) followed by retroperitoneal fibrosis or adhesions.
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