Question
A 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first-line option for relief is:
| A. |
Percutaneous embolization of gonadal veins
|
| B. |
Radiofrequency ablation of testicular veins
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| C. |
Laparoscopic excision of affected testes
|
| D. |
Excision of pampiniform plexus
|
Show Answer
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Correct Answer » A
Explanation
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|
- The patient has a varicocele, characterized by:
- Dull, dragging scrotal pain.
- A “bag of worms” feel on palpation.
- Swelling that becomes more prominent on standing or during the Valsalva maneuver.
- Disappearance of the swelling on lying down due to venous drainage.
- Varicoceles are caused by dilatation of the pampiniform venous plexus due to incompetent valves of the internal spermatic vein.
- Approximately 90% occur on the left side because the left testicular vein drains into the left renal vein at a right angle.
Explanation of the Correct Answer
Option A. Percutaneous embolization of the gonadal veins
- Percutaneous embolization is a minimally invasive technique that occludes the refluxing gonadal vein using coils or sclerosants.
- It is an accepted treatment option, particularly in recurrent varicoceles or when surgery is undesirable.
- As microsurgical varicocelectomy is not listed, this is the best available option.
Why the Other Options are Incorrect
Option B. Radiofrequency ablation of the testicular veins
- Incorrect.
- Radiofrequency ablation is not a standard treatment for varicocele.
Option C. Laparoscopic excision of the affected testis
- Incorrect.
- Orchiectomy has no role in the management of uncomplicated varicocele.
Option D. Excision of the pampiniform plexus
- Incorrect.
- The standard operation is ligation of the dilated internal spermatic veins, preserving the testicular artery and lymphatics.
- Excision of the pampiniform plexus is not a recommended or standard procedure.
