Varicocele

A varicocele is an abnormal enlargement of the pampiniform venous plexus in the spermatic cord. The problem is venous drainage: incompetent or absent valves allow blood to reflux, increasing hydrostatic pressure and stretching the veins. The left side is affected more often because the left gonadal vein drains into the left renal vein, where venous pressure can be increased by the renal vein’s anatomy and the “nutcracker” effect of the superior mesenteric artery. The enlarged veins can interfere with the scrotum’s countercurrent heat-exchange system. Excess local heat, venous congestion, and altered testicular circulation may impair spermatogenesis or testicular growth, but many varicoceles never cause infertility or pain. The clinical question is therefore not simply, “Is a varicocele present?” It is, “Is it affecting testicular development, fertility, comfort, or appearance?”