Varicocele presentation ppt akdjfjfjskacnnxnznxnc

Vericocele

1. VARICOCELE DR.ZAIN MUKHTAR Post graduate resident jinnah hospital lahore

2. DEFINITION Varicocele is an abnormal dilatation and tortuosity of internal spermatic veins within pampiniform plexus

3. Blood supply of testis Testicular artery arising from abdominalAorta at level of L2 vertebra

4. Venous drainage of testis Veins emerging from testis form pampiniform plexus.The plexus condenses into 4 veins at Superficial inguinal ring and into 2 veins at Deep inguinal ring.Ultimately one testicular Vein is formed that drains into inferior vena Cava on right side and left renal vein on left side

5. Lymphatic drainage of testis Pre aortic and para aortic lymph nodes at L2 vertabra

6. Pathophysiology Pathophysiology of varicocele is multifactorial Valvular incompetence Collateral venous anastomosis Increased venous pressure in left testicular vein pelvic or abdominal mass left renal cell carcinoma with tumor extension into left renal vein Nut cracker phenomenon occurring in RCC,retroperitoneal fibrosis

7. Effect of varicocele on Testicular function The mechanism by which varicocele exerts an effect on testicle remains unclear.Several theories have been postulated One theory postulates that there is inhibition of spermatogenesis through reflux of warm corporeal blood around testis resulting in elevation of intratesticular temperature Other theories: Pituitary gonadal hormonal dysfunction Internal spermatic vein reflux of renal and adrenal metabolites Increase in hydrostatic pressure associated with venous reflux

8. Grades of Varicocele There are 4 grades of varicocele Grade 0: (subclinical) nonpalpable and visualized only by color dopler ultrasound (CDUS) Grade 1 :(small) palpable only with Vasalva maneuver Grade 2: (moderate) easily palpable but not visible Grade 3: (large) easily visible

9. Investigations Scrotal color dopler ultrasound Venography (gold standard, reserved for embolization and recurrence) Semen analysis

10. Ulltrasound criteria for diagnosing Varicocele There are 2 criterias for diagnosing Varicocele on ultrasound 1.Spermatic vein diameter >2mm 2.Retrograde blood flow on Valsalva maneuver >38cm/sec

11. Complications Infertility Testicular hypotrophy Scrotal discomfort/Pain

12. Indications for varicocele repair Infertility Pain Bilateral large varicocele varicocele in solitary testis Testicular hypotrophy by >20% as compared with non affected side

13. Management Supra inguinal/high retroperitoneal( Palomo ) varicelectomy muscle splitting incision is given medial to ASIS Inguinal varicelectomy inguinal canal in incised Subinguinal microsurgical varicelectomy small tranverse incision is given below superficial ring it has higher success rate Laparoscpic varicelectomy Sclerotherapy or embolotherapy Transfemoral venous puncture done to inject sclerosing agent

14. Complications of varicocelectomy Recurrence Hydrocele Damage to testicular artery and testicular atrophy Ilioinguinal nerve damage Infection hematoma

15. THANKYOU