Varicocoele is the dilatation of the pampiniform plexus of veins, a network of many small veins found in the male spermatic cord. It is the most frequently encountered mass of the spermatic cord.

The estimated incidence is at ~15% of general male population and ~40% of subfertile and infertile men (most common cause of correctable male infertility).

Varicocoeles can be asymptomatic. If symptomatic presentations include:

  • scrotal mass/swelling
  • scrotal pain
  • testicular atrophy
  • infertility or subfertility

The pampiniform veins normally act as heat exchangers, important in the thermoregulation of the testes which is vital for spermatogenesis. A varicocoele disturbs this balance and causes heating up of the testis to the normal core body temperature (37 ºC), whereas they are normally maintained at a temperature of 35 ºC. 

A varicocoele can be classified as primary or secondary.

Most varicocoeles are primary and result from incompetent or congenitally-absent valves in the testicular vein (internal spermatic vein).

The left side testicle is affected much more commonly (≈85%) than the right. This may be due to the shorter course of right testicular vein and its oblique insertion into the IVC which creates less back pressure. Bilateral varicocoeles are not uncommon (≈15%), but isolated right varicocoeles are rare and should prompt evaluation for a secondary varicocoele.

Secondary varicocoeles are much less common and result from increased pressure in the testicular vein due to compression (e.g. extrinsic mass), obstruction (e.g. renal vein thrombus), or splenorenal shunting (portal hypertension). 

Diagnostic modality of choice:

  • may show a dilated cluster of enhancing serpentine veins
  • may be incidentally noted during scrotal MRI
  • dilated enhancing serpentine veins
  • signal intensity depends on velocity of flow
    • low flow: intermediate T1 and high T2
    • high flow: signal void
  • enhancement following gadolinium administration

Venography, only performed during endovascular treatment, may demonstrate

  • dilated testicular veins
  • retrograde flow of contrast towards the scrotum
  • dilated pampiniform plexus should not be directly imaged as the testes should be kept out of the x-ray beam

This is among one of the surgically-correctable causes of male infertility. Management options include:

A unilateral right-sided varicocoele is an uncommon finding, and if found, should prompt an evaluation of the retroperitoneum to exclude a mass obstructing the downstream testicular vein.

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Article information

rID: 4631
Synonyms or Alternate Spellings:
  • Varicocele
  • Varicocoeles
  • Varicoceles
  • Scrotal varicocele
  • Scrotal varicoceles
  • Scrotal varicocoeles
  • Scrotal varicocoele

Cases and figures

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    Case 2
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    Dilated, tortuous...
    Case 3
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    Left spermatic cord
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    Case 6
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