A 35 year old male seeks an evaluation for infertility after failed attempts at conception. He also reports scrotal heaviness. On examination,following is seen.What are the indications of surgery in this condition?
B. Small testis
D. All of the above
Ans:D. All of the above.
- A varicocele is a dilatation of the pampiniform venous plexus and the internal spermatic vein.
- Varicoceles are much more common (approximately 80-90%) in the left testicle than in the right because of several anatomic factors, including the following:
- 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
- The increased renal vein pressure due to its compression between the superior mesenteric artery and the aorta.
- A patient with a varicocele is usually asymptomatic and often seeks an evaluation for infertility after failed attempts at conception. He may also report scrotal pain or heaviness. Careful physical examination remains the primary method of varicocele detection. An obvious varicocele is often described as feeling like a bag of worms.
- Reasons for surgical correction of a diagnosed variocele include relieving significant testicular discomfort or pain not responsive to routine symptomatic treatment, reducing testicular atrophy (volume <20 mL, length <4 cm), and addressing the possible contribution to unexplained male infertility.