Varicocele is a dilation (enlargement) of the internal spermatic
veins that drain the testicle.
Varicoceles are much more common (80-90%) in the left testicle
than in the right because of several anatomic factors, including
the angle at which the left testicular vein enters the left renal
vein, the lack of effective antireflux valves at the juncture
of the testicular vein and renal vein, and the increased renal
vein pressure due to its compression between the superior mesenteric
artery and the aorta (nutcracker effect). Numerous theories postulate
how a varicocele can affect fertility: 1.Testicular temperature
increases due to abnormal blood flow in the veins draining the
testicle. 2.Abnormal concentrations of adrenal and renal substances
may impede development of normal sperm. 3.Abnormal blood flow
can also interfere with testosterone concentration, which in turn
can interfere with sperm production.
Sometimes, these varicoceles cause no symptoms and are harmless.
But sometimes they can cause pain or atrophy (shrinkage), or fertility
problems. A varicocele may cause progressive damage to the testes,
resulting in further atrophy and impairment of seminal parameters.
Color-flow Doppler ultrasonography defines the anatomic and physiologic
aspects of varicoceles by using real-time ultrasonography and
pulsed Doppler in the same scan. The color of the signal identifies
the blood flow and direction within the varicocele. The characteristic
reverse flow of varicoceles is confirmed by prolonged flow augmentation
within a colored flow area; the flow changes color (reverses)
on real-time imaging A varicocele is a common entity described
as an abnormal dilatation exceeding 2 mm in diameter of the veins
of the pampiniform venous plexus associated with tortuosity. The
normal diameter is up to 2.2 mm, which may increase to 2.7 mm
during valsalva. The incidence of sub-clinical varicocele diagnosed
by color Doppler ultrasound is even higher. The veins forming
a varicocele are usually uniform in size measuring up to 5 mm
in diameter. The vessel size increases if the patient is scanned
when standing or whilst a valsalva manoeuvre is performed. Color
flow Doppler ultrasound bas provided the highest level of confidence
by demonstrating flow within a varicocele. Intratesticular varicocoele
: Intratesticular varicocele is an extremely rare condition characterized
by dilated Intratesticular veins and associated with ipsilateral
varicocele. The mechanism of causation is the same as extratesticular
varicocele. The dilated Intratesticular veins are seen as straight
or serpentine hypoechoic tubular structures within the mediastinum
testis radiating into the testicular parenchyma.
Intrascrotal cyst and spermatocoele.
Testicular cystic neoplasm.
Fluid-filled bowel loop (hernia).
No effective medical treatments for varicoceles have been identified.
Surgical therapy: Reasons for surgical correction of a diagnosed
varicocele include relieving significant testicular discomfort
or pain not responsive to routine symptomatic treatment, reducing
testicular atrophy, and addressing the possible contribution to
unexplained male infertility.
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