Varicocele: Pathogenesis and clinical findings Primary: - Anatomically: the left spermatic vein drains into the left renal vein - Nutcracker Effect: The left renal vein can get pinched by the abdominal aorta and superior mesenteric artery Backup of blood in left renal vein - Increased pressure in left spermatic vein Secondary: - Renal cell carcinoma or retroperitoneal masses - Inferior vena cava thrombus - External compression of spermatic vein - Obstruction of blood flow - Increased spermatic vein pressure -> Vein valve leaflet failure & retrograde bloodflow back towards testicle -> Dilation of pampiniform plexus and scrotal vein plexus -> Varicocele Notes: • 90% present as left sided. • Primary varicocele ache and scrotal venous distention can be relieved by superincumbent positioning (increases venous return). • Small varicoceles can be identified by preforming the Valsalva maneuver (decreases venous return). • Unilateral right varicoceles are uncommon and should be investigated for underlying pathology causing obstruction. #Varicocele #Pathophysiology #Signs #Symptoms #Urology #Diagnosis
