Q&A: Clinical Conditions Associated With Varicoceles

The spectrum of conditions that affect the scrotum and its contents ranges from incidental findings that require patient reassurance to acute pathologic events that necessitate expeditious diagnosis and treatment. The most common nonacute scrotal conditions include varicocele, hydrocele, epididymal cyst and spermatocele, testicular cancer, chronic epididymitis, and cryptorchidism.

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In this article:
Symptoms of a varicocele
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

Symptoms of a varicocele

Symptoms of a varicocele may include:

• Dragging-like or aching pain within scrotum.
• Feeling of heaviness in the testicle(s)
• Atrophy (shrinking) of the testicle(s)
• Low testosterone.
• Visible or palpable (able to be felt) enlarged vein

Varicoceles have also been implicated as a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to shrink. Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and many don't need treatment. If a varicocele causes symptoms, it often can be repaired surgically.

MCQ exam: clinical scenario

A 54 year old man has a rapidly developing left-sided varicocele.

This may be secondary to:

a). Juvenile rheumatoid arthritis
b). Scleroderma
c). Epidermolysis bullosa
d). Bronchial carcinoma
e). Renal carcinoma

MCQ exam: answer

The correct answer is E

MCQ exam: explanation

A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains blood from the testicles back to the heart. 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. Upward 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 testicular veins near the testis, leading to the formation of a varicocele. Varicoceles occur in around 15% to 20% of all men, with its incidence increasing with age.

Rarely, renal cell carcinoma of the left kidney extends along the left renal vein and blocks the exit of the testicular vein. A rapidly developing left-sided varicocele should therefore always prompt examination of the left kidney.

Reference(s)
1). Mayo Clinic: Varicocele. Retrieved 31 July 2012. Available online: https://www.mayoclinic.org/diseases-conditions/varicocele/symptoms-causes/syc-20378771
2). UpToDate: Nonacute scrotal conditions in adults. Retrieved 16 June 2020. Available online: https://www.uptodate.com/contents/nonacute-scrotal-conditions-in-adults
3). White, Wesley M.; Kim, Edward David; Mobley, Joe D (2 January 2019). "Varicocele: Epidemiology". Medscape. Retrieved 18 September 2019. Although varicoceles appear in approximately 20% of the general male population, they are much more common in the subfertile population (40%)."
4). Kupis, Ł; Dobroński, PA; Radziszewski, P (2015). "Varicocele as a source of male infertility - current treatment techniques". Central European Journal of Urology. 68 (3): 365–70. doi:10.5173/ceju.2015.642. PMC 4643713. PMID 26568883.