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Varicocele or bag of worms

Varicocele is a common cause of male infertility . Varicocoele is a condition where the veins in the spermatic cord in the scrotum are abnormally dilated and tortuous.

Varicocele is the commonest cause of low sperm count with poor motility (oligoasthenozoospermia). Fifteen percent of the general male population. Forty percent of men evaluated for primary infertility and  Fifty percent of men evaluated for secondary infertility have varicocele.

Varicocele , in fact is the most common identifiable and surgically correctable factor contributing to poor testicular function and decreased semen quality.

How is it Diagonised?

A) Clinical Examination: The doctor examines the patient in the standing posture and feels the spermatic cord - the cord-like structure from which the testis hangs. Varicocele feels like a bunch of worms in a bag. On coughing, this feel gets transiently exaggerated.

B) Color doppler sonography  is the most accurate and objective method of detecting and documenting a varicocele.

Grades of varicocele:

Grade III or Large  On inspection one can see the 'bag of worms'
Grade II or Moderate  On palpation without coughing one can feel the 'bag of worms'
Grade I or Small  Only on coughing can one feel the 'bag of worms'
Subclinical Varicocele  Detected only by color doppler

what causes varicocele?

Numerous theories have been suggested.

  • Left testicular vein enters the left renal vein perpendicularly

  • Long (8 - 10 cm) left testicular vein (aided by gravity)

  • Compression of left renal vein between aorta and superior mesenteric artery ('nut cracker' effect)

  • Absence or incompetent valves in testicular vein.                                              

Indications for surgery

  1. Pain
    Varicocele may cause dragging pain in scrotum in 5% to 10% of patients.

  2. Stress pattern of semen
    a) Low sperm count (oligospermia)
    b) Poor motility (asthenospermia)
    c) Abnormal forms
    d) Tapered forms

  3. Testicular Atrophy
    Loss of Testicular size, Flabby testes

The mere presence of varicocele doesn't mean that surgical correction is necessary.


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