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A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum, affecting about 15% of men, particularly adolescents and young adults. It can lead to symptoms such as discomfort, visible enlarged veins, and infertility due to impaired spermatogenesis. Treatment options include conservative management for mild cases and surgical interventions for more severe symptoms or infertility.

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36 views3 pages

Surgical Presentation

A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum, affecting about 15% of men, particularly adolescents and young adults. It can lead to symptoms such as discomfort, visible enlarged veins, and infertility due to impaired spermatogenesis. Treatment options include conservative management for mild cases and surgical interventions for more severe symptoms or infertility.

Uploaded by

sorieturay666
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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VARICOCELE

Definition

A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum,


which drains blood from the testicles. It is often described as feeling like a "bag of worms."

Epidemiology

 Affects approximately 15% of men overall.


 More common in adolescents and young adults.
 Occurs most often on the left side due to anatomical reasons.

Causes

 Primary varicocele: Caused by incompetent or absent valves in


the testicular vein, leading to blood pooling.
 Secondary varicocele: Caused by compression of the testicular
vein (e.g., by a tumor or mass in the abdomen or kidney).

Pathophysiology

 Increased venous pressure leads to venous dilation.


 Impaired blood flow causes increased scrotal temperature,
oxidative stress, and hypoxia in the testicle.
 This can negatively affect spermatogenesis, possibly causing
infertility.

Symptoms

 Often asymptomatic.
 May present with:
o A dull ache or discomfort in the scrotum.
o A sensation of heaviness.
o Visible or palpable enlarged veins ("bag of worms").
o Atrophy (shrinking) of the affected testicle.
o Infertility or subfertility in some men.

Diagnosis

1. Physical Examination:
o Performed while standing and during Valsalva maneuver.
o Graded as:
 Grade I: Small, palpable only during Valsalva.
 Grade II: Palpable without Valsalva.
 Grade III: Visible through scrotal skin.

2. Scrotal Ultrasound with Doppler:


o Confirms diagnosis.
o Measures venous diameter and retrograde blood flow.

Complications

 Infertility: Due to impaired spermatogenesis.


 Testicular atrophy: Especially in adolescents.
 Pain and discomfort: In chronic cases.

Treatment
Conservative Management (for asymptomatic or mild cases)

 Scrotal support (e.g., supportive underwear).


 Analgesics (NSAIDs) for pain.
 Monitoring if fertility is not a concern.

Surgical Treatment (indicated for infertility, pain, or testicular atrophy)

1. Varicocelectomy:
o Microsurgical subinguinal (preferred due to low recurrence).
o Inguinal or laparoscopic approaches.
o Ligation of dilated veins to stop backflow.

2. Percutaneous Embolization:
o Minimally invasive.
o Uses coils or sclerosants to block the vein.

Prognosis

 Good with treatment.


 Surgery can improve sperm quality and testosterone levels.
 Not all varicoceles require treatment unless symptomatic or associated
with infertility.

Nursing Considerations

 Provide pre- and post-operative care if surgery is done.


 Educate the patient about scrotal support, hygiene, and activity
restrictions post-surgery.
 Monitor for signs of infection or recurrence.
 Counsel about fertility options if affected.

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