October 30, 2013

Concerning the causes of varicoceles

A 54 year old man has a rapidly developing left-sided varicocele. This may be secondary to:
  1. Juvenile rheumatoid arthritis
  2. Scleroderma
  3. Epidermolysis bullosa
  4. Bronchial carcinoma
  5. Renal carcinoma

The correct answer is E

Rarely, renal cell carcinoma of the left kidney extends along the left renal vein and blocks the exit of the testicular vein. A rapidly developing left-sided varicocele should therefore always prompt examination of the left kidney.

More about Varicoceles [Wikipedia]
Varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains the testicles.

The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis.

Upward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves, or compression of the vein by a nearby structure, can cause dilatation of the testicular veins near the testis, leading to the formation of a varicocele.

Symptoms of a varicocele may include:
  • Dragging-like or aching pain within scrotum.
  • Feeling of heaviness in the testicle(s)
  • Atrophy (shrinking) of the testicle(s)
  • Low testosterone.
  • Visible or palpable (able to be felt) enlarged vein
Varicoceles have also been implicated as a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to shrink.[Mayo Clinic]

Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and many don't need treatment. If a varicocele causes symptoms, it often can be repaired surgically.

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