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Encyclopedia > Varicocele
Varicocele
Classification & external resources
ICD-10 I86.1
ICD-9 456.4
DiseasesDB 13731
MedlinePlus 001284
eMedicine radio/739 
Cross section showing the pampiniform plexus

Varicocele is an abnormal enlargement of the veins in the scrotum draining the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Up-ward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves, or compression of the vein by a nearby structure, can cause dilatation of the veins near the testis, leading to the formation of a varicocele. The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Image File history File links Gray1147. ... Image File history File links Gray1147. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... In some male mammals, the scrotum is a bag of skin and muscle containing the testicles. ... Human male anatomy The testicles, known medically as testes (singular testis), are the male generative glands in animals. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... The inguinal canal is a passage in the anterior abdominal wall which in men conveys the spermatic cord and in women the round ligament. ... Male Anatomy The spermatic cord is the name given to the cord-like structure formed by the vas deferens and surrounding tissue (veins, arteries, nerves, and lymphatic vessels) that run from the abdomen down to each testicle. ... Human male anatomy The testicles, known medically as testes (singular testis), are the male generative glands in animals. ...

Contents

Anatomy

The term varicocele specifically refers to dilatation and tortuosity of the pampiniform plexus, which is the network of veins that drain the testicle. This plexus travels along the posterior portion of the testicle with the epididymis and vas deferens, and then into the spermatic cord. This network of veins coalesces into the gonadal, or testicular, vein. The right gonadal vein drains into the inferior vena cava, while the left gonadal vein drains into the left renal vein, which then drains into the inferior vena cava. The spermatic veins emerge from the back of the testis, and receive tributaries from the epididymis: they unite and form a convoluted plexus, the plexus pampiniformis, which forms the chief mass of the cord. ... This article may be too technical for most readers to understand. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ...


The small vessels of the pampiniform plexus normally range from 0.5-1.5 mm in diameter. Dilatation of these vessels greater than 2 mm is called a varicocele.


Etiology

The idiopathic varicocele occurs when the valves within the veins along the spermatic cord don't work properly. This is essentially the same process as varicose veins, which are common in the legs. This results in backflow of blood into the pampiniform plexus and causes increased pressures, ultimately leading to damage to the testicular tissue. Vein gymnastics in the barefoot park Dornstetten, Germany. ...


Varicoceles usually develop slowly and may not have any symptoms. There are most frequently diagnosed when a patient is 15-25 years of age, and rarely develop after the age of 40. They occur in 15-20% of all males, and in 40% of infertile males.


98% of idiopathic varicoceles occur on the left side, apparently because the left testicular vein runs vertically up to the renal vein, while the right testicular vein drains directly into the vena cava. 70% of patients with varicoceles have them bilaterally. Isolated right sided varicoceles are rare, and should prompt evaluation for an abdominal or pelvic mass (see secondary varicocele, below). Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... The superior and inferior venae cavae are the veins that return the blood from the body into the heart. ...


A secondary varicocele is due to compression of the venous drainage of the testicle. A pelvic or abdominal malignancy is a definite concern when a varicocele is newly diagnosed in a patient older than 40 years of age. One non-malignant cause of a secondary varicocele is the so-called "nut-cracker SMA" (superior mesenteric artery), a condition in which the superior mesenteric artery compresses the left renal vein, causing increased pressures there to be transmitted retrograde into the left pampiniform plexus.


Symptoms

Symptoms of varicoele may include:

  • Ache in the testicle
  • Feeling of heaviness in the testicle(s)
  • Infertility
  • Shrinkage (atrophy) of the testicle(s)
  • Visible or palpable (able to be felt) enlarged vein[1]

Diagnosis

Upon palpation of the scrotum, a non-tender, twisted mass along the spermatic cord is felt (it feels like a bag of worms.) The mass may not be obvious, especially when lying down. The testicle on the side of the varicocele may or may not be smaller compared to the other side.


Varicocele can be reliably diagnosed with ultrasound, which will show dilatation of the vessels of the pampiniform plexus to greater than 2 mm. The patient being studied should undergo a provocative maneuver, such as a Valsalva maneuver (straining, like he is trying to have a bowel movement) or standing up during the exam, both of which are designed to increase intraabdominal venous pressure and increase the dilatation of the veins. Doppler ultrasound is a technique of measuring the speed at which blood is flowing in a vessel. An ultrasound machine that has a Doppler mode can see blood reverse direction in a varicocele with a Valsalva, increasing the sensitivity of the examination. A fetus in its mothers womb, viewed in a sonogram (brightness scan) A fetus, aged 29 weeks, in a 3D ultrasound Ultrasound is sound with a frequency greater than the upper limit of human hearing, this limit being approximately 20 kilohertz (20,000 hertz). ... In medicine, the Valsalva maneuver is performed by forcibly exhaling against closed lips and pinched nose, forcing air into the middle ear if the Eustachian tube is open. ...


Treatment

Varicoceles may be managed with a scrotal support (e.g. jockstrap, briefs). However, if pain continues or if infertility or testicular atrophy results, the varicocele may need to be surgically ligated (tied off). A jockstrap, also known as a jock or athletic supporter, is a type of mens undergarment designed for use in sports or other activities, such as during the recovery from a vasectomy. ... Briefs are a type of Y-shaped underwear and swimwear, as opposed to styles where the material extends down the legs. ... Atrophy is the partial or complete wasting away of a part of the body. ...


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). Various other techniques may be used. Ice packs should be kept to the area for the first 24 hours after surgery to reduce swelling. The patient may be advised to wear a scrotal support for some time after surgery. The inguinal canal is a passage in the anterior abdominal wall which in men conveys the spermatic cord and in woman the round ligament. ... Retroperitoneal is an anatomical term that refers to the relationship of the contents of the abdominal cavity to the peritoneal space. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ...


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. Hematoma on an elbow, nine days after a blood sample was taken Hematoma on a forearm, one day after repeated shocks A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage. ... An infection is the detrimental colonization of a host organism by a foreign species. ...


An alternative to surgery is embolisation, a non-invasive treatment for varicocele that is performed by an interventional radiologist. This involves passing a small wire through a peripheral vein and into the abdominal veins that drain the testes. Through a small flexible catheter, this doctor can obstruct the veins so that the increased pressures from the abdomen are no longer transmitted to the testicles. The testicles then drain through a bunch of smaller, collateral veins. The recovery period is significantly less than with surgery and the risk of complications is minimised. However, overall effectiveness is not as high as surgery, which is still an option. Interventional Radiology (abbreviated IR or sometimes IVR) is a subspecialty of radiology in which minimally invasive procedures are performed using image guidance. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity duct or vessel. ...


Prognosis

A varicocele is usually harmless and sometimes requires no treatment. If surgery is required because of infertility or testicular atrophy, the outlook is usually excellent. Removal of varicocele can lead to normal testicular temperatures and an increased sperm production.


Varicocele and Infertility

Whether or not a varicocele causes infertility is a contentious issue. Recent research suggests that there may be no improvement in fertility after treating a varicocele with surgery; indeed, the research implies that there may not even be a reliable causal link between the presence of a varicocele and infertility in males [2].


References

  1. ^ Urologychannel: Varicoele - URL retrieved October 21, 2006
  2. ^ BBC News: Varicocele

October 21 is the 294th day of the year (295th in leap years) in the Gregorian Calendar, with 71 days remaining. ... For the Manfred Mann album, see 2006 (album). ...

Source

  • Varicocele. MedlinePlus Medical Encyclopedia. US Federal Government public domain. Update Date: 12 November 2003. Updated by: Scott M. Gilbert, M.D., Department of Urology, Columbia-Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
  • Diagnostic Ultrasound, wnd Ed. Rumack, Wilson, Charboneau (ed.) Mosby 1998.

November 12 is the 316th day of the year (317th in leap years) in the Gregorian Calendar, with 49 days remaining. ... 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ...

External links

  • Patient UK has a nice patient oriented, but detailed explanation of Varicoceles
  • The Royal College of Radiologists has good information on Varicocele Embolisation

  Results from FactBites:
 
eMedicine - Varicocele : Article by Wesley M White (4446 words)
A varicocele is a dilatation of the pampiniform venous plexus and the internal spermatic vein.
Varicocele is a well-recognized cause of decreased testicular function and occurs in approximately 15-20% of all males and in 40% of infertile males.
Scrotal examination for varicocele should be a facet of the standard urologic physical examination because of the potential for varicoceles to cause significant testicular damage.
IVF Procedure - In Vitro Fertilization and PGD - Chicago Infertility Specialist - Varicocele (812 words)
Varicocele is the presence of enlarged or dilated veins in the blood vessels of the scrotum.
It is estimated that varicoceles are present in about 20% of the normal fertile male population and up to 40% of an infertile population.
Varicocele and In Vitro Fertilization - IVF and Intracytoplasmic Sperm Injection -ICSI
  More results at FactBites »

 
 

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