Varicocoele

Described as “a bag of worms” by Dubin and Amelar in 1970, varicoele is an abnormal venous dilation the pampiniform plexus of the spermatic cord and scrotum (1).

The condition is almost always larger and more common on the left side. Three commonly accepted theories exist to explain this occurrence:

• left testicular vein drains into the high pressure renal vein; the right, into the low pressure inferior vena cava
• lack of valves in the internal spermatic vein and/or the reflux caused by venous collateral flow
• ‘the nutcracker phenomenon’ – partial obstruction of the testicular vein
  • proximal type - the left renal vein is compressed by the aorta and the superior mesenteric artery
  • distal type - the left common iliac artery compresses the left common iliac vein

The prevalence of varicocele varies widely within the literature.

• varicoceles are reported to be present in 15% of the general male population (2)
  • within the subfertile population, this number is higher – in 35% - 50% of men with primary infertility and in 69%–81% of men with secondary infertility
• it is an unsusal finding in children younger than 10 years, on the other hand, in children between the age of 10 to 19 years, the incidence increases rapidly to about 10-20%, comparable with the incidence found in adults
• a significant increase in prevalence is observed in first-degree relatives (particularly brothers) of patients with known varicoceles (2,3,4)

Varicocele may be associated with the following andrological conditions:

• failure of ipsilateral testicular growth and development
• symptoms of pain and discomfort
• male subfertility
• hypogonadism (5).

Reference:

1. Sener NC et al. Varicocele: A review. EMJ Repro Health. 2015;1[1]:54-58.
2. Alsaikhan B, Alrabeeah K, Delouya G, Zini A. Epidemiology of varicocele. Asian Journal of Andrology. 2016;18(2):179-181.
3. Shridharani A, Owen RC, Elkelany OO, Kim ED. The significance of clinical practice guidelines on adult varicocele detection and management. Asian Journal of Andrology. 2016;18(2):269-275.
4. Waalkes R et al. Varicocele in adolescents: a review and guideline for the daily practice. Arch Esp Urol. 2012;65(10):859-71.
5. European Association of Urology (EAU) 2015. Guidelines in male infertility.