Varicocele

Varicocele is due to abnormal dilation of spermatic cord veins, also known as the pampiniform plexus, due to faulty valvular venous return.

Most varicoceles occur on the left, possibly due in part to the acute angle of confluence with the left renal vein and resulting higher IV pressure.

Classically, the mass of enlarged veins can be palpated superior and posterior to the testis (“bag of worms”), and is more prominent when standing or with Valsalva maneuver.

The sudden onset of a right varicocele should raise the question of a retroperitoneal malignancy resulting in obstruction of the right spermatic vein. Varicocele may lead to infertility in some men.

Renal Cell Carcinoma arises from the PCT and is usually polar in location. The tissue of origin for renal cell carcinoma (RCC) is the proximal renal tubular epithelium. It is more common in males. The classic triad of flank pain, hematuria, and flank mass. The most common presentations include hematuria (40%).  Other signs and symptoms include weight loss (33%), fever (20%), hypertension (20%), hypercalcemia (5%), night sweats, malaise, and a varicocele, usually left sided, due to obstruction of the testicular vein (2% of males).

Ans. is ‘a’ i.e., Radiosensitive

RCC or hypernephroma is one of the most radioresistant and chemoresistant tumors.

In men rapidly developing varicocele is rare but impressive sign for RCC occuring most often on the left side. It occurs because left gonadal vein is obstructed where it joins the left renal vein.

As already stated RCC originates in the cortex and tends to grow out into perinephric tissue causing characteristic bulge or mass effect.

About adenomas

Adenomas are the most common benign renal parenchymal lesions.

– Despite the classification of adenoma as a benign tumor, no clinical, histologic or immunohistochemical criteria can differentiate renal adenoma from renal carcinoma.

• Smith’s Urology writes about adenomas ‑

– “Previously, all renal tumors less than 3 cm were considered adenomas. However, even such small tumors can metastasize and are now classified as renal cell carcinoma. Adenomas of any size should be treated as a fortuitous finding representative of an early renal cancer, and the patient should be evaluated and treated appropriately.”

Ans. is ‘c’ i.e., More common in female

Ans. is ‘a’ ie Common on the Rt. side 

Varicocele

• It is seen 95% of times on left side.

Several anatomic features contribute to the predominance of left-sided varicoceles. The left internal spermatic vein is longer than the right; in addition, it usually joins the left renal vein at right angles. The right internal spermatic vein has a more oblique insertion into the inferior vena cava. This particular anatomy in the standing man may cause higher venous pressures to be transmitted to the left scrotal veins and result in retrograde reflux of blood into the pampiniform plexus.

• Clinical picture
• Age – young adult
• Tall thin men are frequently affected*
• Bag of worms* like feel on palpation
• The veins empty in supine position (so examination is always done in standing position)
• Infertility : The varicocele is the most common cause of male infertility world wide. In approximately 70% of patients with secondary infertility, a varicocele is an underlying cause. [Ref: Urologic Clinics of North America ‑

Volume 35, Issue 2 (May 2008)]

“The World Health Organization concluded that varicoceles are clearly associated with impairment of testicular function and infertility.” [Ref: Cambell’s Urology 9/e]

Ans is ‘b’ i.e., Left testicular vien drains into Left renal vein which has high pressure

• Variocele formation has been attributed to one of the three primary factors : (Ref.- Cambell’s Urology)

a)          Increased venous pressure in left renal vein

b)         Collateral venous anastomoses

c)          Absent or incompetent valves in the internal spermatic vein.

Ans is a (Small testis), b (Pain), c (Oligospermia) 

Ans:B.)More common on Right Side.

Varicocele

• A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains blood from the testicles.
• The varicoceles might be noticed as soft lumps, usually above the testicle and mostly on the left side of the scrotum. Some people who have them feel pain or heaviness in their scrotum. An obvious varicocele is often described as feeling like a bag of worms.
• 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 (ie, nutcracker effect).
• Varicocele may be seen in Renal Tumor due to obstruction of the testicular vein

Ans. is ‘d’ i.e., Frequently on right side 

Ans. is ‘a’ i.e., Varicocele 

Ans. is ‘c’ i.e. asymptomatic cases require surgery 

Ans. is ‘a’ i.e., Varicosity of cremestric veins 

Answer is D (Radiosensitive):

Renal cell carcinoma is a relatively radioresistant tumor.

Renal cell carcinoma originates in the Renal cortex

`Renal cell carcinoma originates in the Renal cortex and tends to grow out into perinephric tissue causing the typical bulge or mass effect that aids in their detection by diagnostic imaging studies’ – Smith’s Urology

Renal Cell carcinoma are adenocarcinomas

Histologically Renal cell carcinoma is most often a mixed adenocarcinoma — Smith’s Urology

Renal cell carcinomas may present with varicocele

‘Renal cell carcinomas may present with Rapidly developing varicocele. Varicocele is usually observed on the left side. This occurs because left gonadal vein is obstructed where it joins the left renal vein.

Renal cell carcinomas are Relatively Radioresistant tumors

Renal cell carcinomas are generally considered radioresistant tumors

Role of Radiotherapy in renal Cell carcinoma

• Preoperative Radiation has shown no impact on survival
• Postoperative Radiation has also shown no evidence of improved survival but may be used as it shows improvement in local control.
• Palliative Radiotherapy has been shown to be effective in metastatic disease to brain, bone and lungs.

Answer is C (More common in female)

Renal cell carcinoma is more common in males.

Renal cell carcinoma is more common in males 

The male to female ratio of RCC is 2:1

Renal cell carcinoma arises from the proximal tubule

‘RCC arise form the proximal tubular epithelium as evidenced by electron microscopy’ — Smith’s Urology 16’h/349

• RCC arise most commonly_, from Renal cortex
• RCC originates most commonly from proximal renal tubular epithelium
• RCC more often arises from the ‘poles’ particularly the upper pole Renal cell carcinoma may invade the Renal vein

Renal cell carcinoma may extend directly into the renal vein and inferior vena acav

Stage III A Disease            Tumor invades main renal vein or IVC

Renal cell carcinoma present with varicocele

‘Renal cell carcinomas may present with Rapidly developing varicocele. Varicocele is usually observed on the left side. This occurs because left gonadal vein is obstructed where it joins the left renal vein.

Ans. A: Cremasteric vein

Varicocelectomy, the surgical correction of a varicocele, is performed on an outpatient basis.

The three most common approaches are inguinal (groin), retroperitoneal (abdominal), and infrainguinal/subinguinal (below the groin).

Possible complications of this procedure include hematoma (bleeding into tissues), infection, or injury to the scrotal tissue or structures.

In addition, injury to the artery that supplies the testicle may occur.

An alternative to surgery is embolization, a non-invasive treatment for varicocele.

Embolization is an effective treatment for post-surgical varicoceles.