![]() ![]() ![]() Varicoceles in the pediatric population: Diagnosis, treatment, and outcomes. The value of ultrasonography in the diagnosis of varicocele. Lorenc T, Krupniewski L, Palczewski P, Gołębiowski M. Internal Spermatic Vein Insufficiency in Varicoceles: A Different Entity in Adults and Adolescents?. Vanlangenhove P, Dhondt E, Van Maele G, Van Waesberghe S, Delanghe E, Defreyne L. Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. surgical ligation of the testicular veinĪ unilateral right-sided varicocele is an uncommon finding, and if found, should prompt an evaluation of the retroperitoneum to exclude a mass obstructing the downstream testicular vein.This is among one of the surgically correctable causes of male infertility. Management options include: enhancement following gadolinium administration.signal intensity depends on the velocity of flow.may be incidentally noted during scrotal MRI.dilated pampiniform plexus should not be directly imaged as the testes should be kept out of the x-ray beam.retrograde flow of contrast towards the scrotum.Venography, only performed during endovascular treatment, may demonstrate: may show a dilated cluster of enhancing serpiginous veins.Doppler ultrasound can be used to grade the degree of reflux.there can be flow reversal with the Valsalva maneuver 4.characteristically have a serpiginous appearance.dilatation of pampiniform plexus veins >2-3 mm in diameter 3,4.renal vein thrombus), or splenorenal shunting ( portal hypertension). extrinsic mass such as retroperitoneal lymphadenopathy or renal mass), obstruction (e.g. Secondary varicoceles are much less common and result from increased pressure in the testicular vein due to compression (e.g. In contrast, the left testicular vein has a longer course and inserts into the left renal vein at a right angle. Bilateral varicoceles are not uncommon (≈15%), but isolated right varicoceles are rare and should prompt evaluation for a secondary varicocele. This may be due to the shorter course of the right testicular vein and its oblique insertion into the IVC which creates less backpressure. The left testis is affected much more commonly (≈85%) than the right. Most varicoceles are primary and result from incompetent or congenitally-absent valves in the testicular vein (internal spermatic vein). EtiologyĪ varicocele can be classified as primary or secondary. A varicocele disturbs this balance and causes heating up of the testis to the normal core body temperature (37✬), whereas they are normally maintained at a temperature of 35✬. The pampiniform veins normally act as heat exchangers, important in the thermoregulation of the testes which is vital for spermatogenesis. Varicoceles are rare in children under the age of ten years, however they may be seen in up to 10-15% adolescents 7. The estimated incidence is at ~15% of the general male population and ~40% of subfertile and infertile men (the most common cause of correctable male infertility). ![]()
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