by Carlo Raj, MD

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    Our topic here is varicocele. What do varices mean to you? Engorgement of your veins. Here we have a varicocele. What’s happening? Dilation of veins, you must know the anatomy in greater detail here. You must know about the pampiniform plexus due to increased venus pressure. How does your increased pressure which is then – Well, the veins, what are they doing? That’s important for you to understand. Are veins draining or supplying? Draining. So if there’s increased pressure in the veins, then you’re having difficulty with the draining. So now, what happens? Engorgement, right? Welcome to varicocele. Concept first, then you plug in the diagnosis. Most common cause of scrotal enlargement is varicocele. Most common cause of scrotal enlargement, hence, know everything about varicocele. What side? Almost always on the left side due to resistance to flow. It’s important that you know the anatomy here. The left testicular vein or gonadal vein drains into the left renal vein. Can you picture that for me? Does that happen on the right side? No. Okay, so pause. On the left side, if the left gonadal vein or testicular vein has to drain into the left renal vein first, then it drains into your inferior vena cava. My goodness, that’s a pretty long journey. And so therefore, if at any point in time there is blockage, then you’re going to have engorgement and enlargement of the scrotum, left side. Simple anatomy, clinical – Everything that you do in medicine between you and I or in general by yourself, make sure you give it a clinical tag. If you don’t, then I don’t know, just leave it aside and come back to it. Acute onset may indicate a thrombotic event. Secondary to nephrotic syndrome or even renal cell carcinoma. Keep that in mind....

    About the Lecture

    The lecture Varicocele by Carlo Raj, MD is from the course Male Reproductive System Diseases.

    Included Quiz Questions

    1. Most common cause of infertility
    2. Most commonly affect left side
    3. Most common cause of scrotal enlargement
    4. Mostly treated conservatively
    5. Might occur bilaterally
    1. Left testicular vein drains directly to left renal vein
    2. Left testicular vein drains directly to left adrenal vein
    3. Left testicular vein drains directly to IVC
    4. Right testicular vein drains directly to right renal vein
    5. Left renal cancers tend to metastasize early to renal vein
    1. Left T3 Adrenal Cancer
    2. Left T 3 renal cancer
    3. Retroperitoneal masses
    4. Nephrotic syndromes
    5. Hypercoagulable states
    1. Positive trans-illumination test
    2. Appear as anechoic tubes on ultrasound
    3. Evidence of backflow is obvious on Doppler ultrasound
    4. On physical exam, they appear as a bag of worms
    5. Increase in size with standing

    Author of lecture Varicocele

     Carlo Raj, MD

    Carlo Raj, MD

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