VARICOCELE OF THE TESTIS

VARICOCELE: DEFINITION AND CLASSIFICATION

A varicocele is defined as ectatic and tortuous veins of the pampiniform plexus of the spermatic cord. Varicoceles are found in 15% of the male adolescents and may cause pain, damage to the testes and infertility.

CLASSIFICATION OF VARICOCELES

Subclinical: no evidence of a varicocele with inspection or palpation, but positive scrotal thermography or Doppler reflux detection.
Grade I: not visible, palpable only with a Valsalva maneuver.
Grade II: not visible, palpable without a Valsalva maneuver.
Grade III: visible through the scrotum without a Valsalva maneuver

ETIOLOGY OF VARICOCELE

Primary Varicoceles

The nearly perpendicular configuration of the renal vein with the left internal spermatic vein combined with incompetent venous valves leads to a long blood column with high pressure. The distal internal spermatic vein and pampiniform plexus become ectatic and further venous valves decompensate. The different configuration of the right internal spermatic vein with the vena cava prevents the reflux of blood and varicocele formation.

TWO TYPES OF VARICOCELE CAN BE DIFFERENTIATED:

Pressure type: retrograde filling of the internal spermatic vein leads to varicocele formation, with no collaterals to the internal or external iliac vein.
Shunt type: severe retrograde filling leads to the formation of a large varicocele with formation of collaterals to the internal or external iliac vein,

Secondary Varicocele

A retroperitoneal mass results in a flow impediment in the internal spermatic vein, which leads to a secondary varicocele.

Increased Testicular Temperature

Increased venous reflux of warm blood from the core of the body increases the temperature of the testis.

Elevated Venous Pressure

Venous reflux leads to an elevated venous pressure leading to a temperature increase and impairment of the testicular blood supply.

SIGNS AND SYMPTOMS OF A VARICOCELE

Usually asymptomatic. Often incidental finding in routine examinations for male infertility.
Palpable mass in the spermatic cord, increasing with rising and with Valsalva maneuver.
Scrotal pain, especially with standing
Testicular atrophy: Normally the testes size varies not more than 20% or 2 ml in comparison to the other side.
The primary varicocele is almost invariably on the left side. The right (and left) varicocele may be a symptom of a retroperitoneal tumor.

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