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Varicocele
Keith B. Quencer, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Anatomy
              • Normal testicular venous drainage
                • Pampiniform plexus → internal spermatic vein (ISV)
                • Left ISV → left renal vein
                  • Anatomic variants of left ISV in 10-20% of cases (multiple gonadal vein branches draining into left renal vein)
                • Right ISV → IVC (anterior-lateral, immediately inferior to right renal vein)
                  • Anatomic variants of right ISV in 20-25% of cases (multiple branches, one of multiple branches draining into right renal vein)
                • ISV a.k.a. gonadal vein and testicular vein
                • Panpifiform plexus a.k.a. spermatic venous plexus
              • Alternative drainage pathways
                • Become primary drainage of testicle with ISV reflux and after embolization
                  • External pudendal vein → greater saphenous vein
                  • Cremasteric vein (a.k.a. external spermatic vein) → inferior epigastric vein
                  • Ductus deferens vein → superior vesicular vein → internal iliac vein
            • Varicocele etiology
              • Internal spermatic vein valvular insufficiency/absence
            • Infertility etiology in presence of varicocele
              • Elevation of testicular temperature
              • Alternative hypotheses less likely
                • Reflux of toxic metabolites
                • Hypoxia from venous stasis
              • Most common abnormality in infertile men
                • Seen in 40% of infertile men, only 15% general male population
                • However, 75% of men with varicocele have normal fertility

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Things to Do

                          OUTCOMES

                          • Complications

                            • Expected Outcome

                              Selected References

                              1. Halpern J et al: Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl. 18(2):234-8, 2016
                              2. Rotker K et al: Recurrent varicocele. Asian J Androl. 18(2):229-33, 2016
                              3. Favard N et al: Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate. Quant Imaging Med Surg. 5(6):806-14, 2015
                              4. Lurvey R et al: Adolescent varicocele: A large multicenter analysis of complications and recurrence in academic programs. J Pediatr Urol. 11(4):186.e1-6, 2015
                              5. Muthuveloe DW et al: The effectiveness of varicocele embolisation for the treatment of varicocele related orchalgia. Springerplus. 4:392, 2015
                              6. Alkaram A et al: Varicocele and its effect on testosterone: implications for the adolescent. Transl Androl Urol. 3(4):413-7, 2014
                              7. Kwak N et al: Imaging and interventional therapy for varicoceles. Curr Urol Rep. 15(4):399, 2014
                              8. Masson P et al: The varicocele. Urol Clin North Am. 41(1):129-44, 2014
                              9. Vanlangenhove P et al: Pathophysiology, diagnosis and treatment of varicoceles: a review. Minerva Urol Nefrol. 66(4):257-82, 2014
                              10. Iaccarino V et al: Interventional radiology of male varicocele: current status. Cardiovasc Intervent Radiol. 35(6):1263-80, 2012
                              11. Diegidio P et al: Review of current varicocelectomy techniques and their outcomes. BJU Int. 108(7):1157-72, 2011
                              12. Cayan S et al: Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 30(1):33-40, 2009
                              13. Reiner E et al: Initial experience with 3% sodium tetradecyl sulfate foam and fibered coils for management of adolescent varicocele. J Vasc Interv Radiol. 19(2 Pt 1):207-10, 2008
                              14. Dubin L et al: Varicocele. Urol Clin North Am. 5(3):563-72, 1978
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Preprocedure

                                  • Procedure

                                    • Outcomes

                                      TERMINOLOGY

                                      • Definitions

                                        • Anatomy
                                          • Normal testicular venous drainage
                                            • Pampiniform plexus → internal spermatic vein (ISV)
                                            • Left ISV → left renal vein
                                              • Anatomic variants of left ISV in 10-20% of cases (multiple gonadal vein branches draining into left renal vein)
                                            • Right ISV → IVC (anterior-lateral, immediately inferior to right renal vein)
                                              • Anatomic variants of right ISV in 20-25% of cases (multiple branches, one of multiple branches draining into right renal vein)
                                            • ISV a.k.a. gonadal vein and testicular vein
                                            • Panpifiform plexus a.k.a. spermatic venous plexus
                                          • Alternative drainage pathways
                                            • Become primary drainage of testicle with ISV reflux and after embolization
                                              • External pudendal vein → greater saphenous vein
                                              • Cremasteric vein (a.k.a. external spermatic vein) → inferior epigastric vein
                                              • Ductus deferens vein → superior vesicular vein → internal iliac vein
                                        • Varicocele etiology
                                          • Internal spermatic vein valvular insufficiency/absence
                                        • Infertility etiology in presence of varicocele
                                          • Elevation of testicular temperature
                                          • Alternative hypotheses less likely
                                            • Reflux of toxic metabolites
                                            • Hypoxia from venous stasis
                                          • Most common abnormality in infertile men
                                            • Seen in 40% of infertile men, only 15% general male population
                                            • However, 75% of men with varicocele have normal fertility

                                      PREPROCEDURE

                                      • Indications

                                        • Contraindications

                                          • Preprocedure Imaging

                                            • Getting Started

                                              PROCEDURE

                                              • Patient Position/Location

                                                • Procedure Steps

                                                  • Alternative Procedures/Therapies

                                                    POST PROCEDURE

                                                    • Things to Do

                                                      OUTCOMES

                                                      • Complications

                                                        • Expected Outcome

                                                          Selected References

                                                          1. Halpern J et al: Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl. 18(2):234-8, 2016
                                                          2. Rotker K et al: Recurrent varicocele. Asian J Androl. 18(2):229-33, 2016
                                                          3. Favard N et al: Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate. Quant Imaging Med Surg. 5(6):806-14, 2015
                                                          4. Lurvey R et al: Adolescent varicocele: A large multicenter analysis of complications and recurrence in academic programs. J Pediatr Urol. 11(4):186.e1-6, 2015
                                                          5. Muthuveloe DW et al: The effectiveness of varicocele embolisation for the treatment of varicocele related orchalgia. Springerplus. 4:392, 2015
                                                          6. Alkaram A et al: Varicocele and its effect on testosterone: implications for the adolescent. Transl Androl Urol. 3(4):413-7, 2014
                                                          7. Kwak N et al: Imaging and interventional therapy for varicoceles. Curr Urol Rep. 15(4):399, 2014
                                                          8. Masson P et al: The varicocele. Urol Clin North Am. 41(1):129-44, 2014
                                                          9. Vanlangenhove P et al: Pathophysiology, diagnosis and treatment of varicoceles: a review. Minerva Urol Nefrol. 66(4):257-82, 2014
                                                          10. Iaccarino V et al: Interventional radiology of male varicocele: current status. Cardiovasc Intervent Radiol. 35(6):1263-80, 2012
                                                          11. Diegidio P et al: Review of current varicocelectomy techniques and their outcomes. BJU Int. 108(7):1157-72, 2011
                                                          12. Cayan S et al: Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 30(1):33-40, 2009
                                                          13. Reiner E et al: Initial experience with 3% sodium tetradecyl sulfate foam and fibered coils for management of adolescent varicocele. J Vasc Interv Radiol. 19(2 Pt 1):207-10, 2008
                                                          14. Dubin L et al: Varicocele. Urol Clin North Am. 5(3):563-72, 1978