Saturday, February 28, 2015

Study group discussion: Varicocele

Some questions regarding varicocele. So what is varicocele?

The increase of the testicular venous pampiniform plexus. Gives the characteristic bag of worms appearance.

Yes! So there is dilatation of this pampiniform plexus!

If it occurs suddenly on the right side. It as an indicative sign of right renal cancer.

Why is left sided varicocele  more common than right?

Left side enters at right angle!

And I am confused.. Which testicular vein drains where?

Right goes in IVC, left in renal. So that's why left is more common
Mnemonic! http://medicowesome.blogspot.ae/2014/03/left-testicular-vein-drains-into.html

What to suspect when you see right sided varicocele which are not common though?

Obstruction of IVC

Brilliant!!!

The right spermatic vein drains at more obtuse angle to IVC. So more likely some obstruction in IVC.

*a debate went on whether varicocele cause sexual dysfunction, sterility, infertility or not. The one who posts the link to the research paper, typically wins*

*Key questions raised* What is the function of this plexus? What would happens if patient is not treated? The pampiniform plexus forms a counter current system with testicular arteries. Hence. Maintaining a low temperature. They take away the heat from the arteries. So azoospermia? The sperms won't survive in the increased temperature? Does the erectile dysfunction occurs in varicocele?

*Conclusion* Varicocele (grade 3) is associated with significant reduction in testicular function with significant increase in serum levels of FSH and LH, which may cause erectile dysfunction and male infertility.
Source: http://www.ncbi.nlm.nih.gov/pubmed/11111867

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