1. Varicocele

3. Introduction
Dilated, elongated & tortuous veins of the spermatic cord

4. Veins of spermatic cord
Veins draining the testis & epididymis
Veins accompanying the vas deferens
Veins of the cremasteric muscles

5. Cross section showing the pampiniform plexus

6. Varicocele: causes Idiopathic: 90% in the left side Tall, thin male
Obstruction at the place of drainage
Retroperitoneal fibrosis
Renal cell carcinoma

7. Varicocele: predilection for the left side
The left testicular vein drains into the left renal vein at right angle whereas the right testicular vein opens into the IVC obliquely
The total length of left testicular vein is longer than the right
In 15% of the cases the left testicular artery arches over the left renal vein
The loaded sigmoid colon may compress the left testicular vein
The left suprarenal vein drains into the left renal vein
Incompetent valves are more common in the left testicular vein
Occasionally the left renal vein may pass between abdominal aorta behind & the superior mesenteric artery in front

8. Varicocele: clinical features
Most are asymptomatic
If they do cause symptoms it is usually a vague or annoying discomfort
Examination shows the typical 'bag of worms'
Heavy sensation after walking or standing
Reduces in size in the supine position
Varicocele is occasionally associated with infertility

9. Varicocele: treatment
Conservative
Surgical

10. Varicocele: conservative treatment
Reassurance
Scrotal support

11. Varicocele: surgical treatment
Varicoceles only need treatment if symptomatic
Veins can be ligated via either a scrotal or inguinal approach
Recent laparoscopic ligation has been reported
Recurrence can occur due to collateral supply via cremasteric vein

12. Varicocele: surgical treatment
Palomo operation

14. Incision for an inguinal approach to varicocele repair.