SEARCH RESULTS FOR: Varicocele

Hydrocele

Hydrocele: Pathogenesis and clinical findings Non-communicating Communicating Congenital patent processus vaginalis Communication between peritoneal cavity and the scrotum Free flow of peritoneal fluid into tunica vaginalis Authors: Luc Wittig Ryan Brenneis Reviewers: Alec Mitchell Darren Desantis* * MD at time of publication Notes: • Hydroceles are typically asymptomatic. • Communicating hydroceles may produce a cough impulse or decrease in size after laying down. Localized infection or trauma Previous varicocelectomy or inguinal surgery Impaired fluid drainage Imbalance between secretion and absorption of fluid in tunica vaginalis Testicular or scrotal malignancy Spermatic cord can still be felt above the testicle & accumulated fluid Accumulation of fluid within tunica vaginalis Hydrocele Increased scrotal fluid volume Increased volume stretches layers of the scrotum Scrotal swelling and heaviness Increased pressure on the testicular structures Accumulated fluid allows light to disperse through the scrotum Fluid motion can occur with external pressure on scrotum Positive fluctuation Compression/ irritation of nerves and pain sensitive structures Scrotal discomfort Longstanding compression of vascular supply, ↓ nutrients to testicles Positive pinch test (done to rule out hernia) Transillumination Testicular Atrophy Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published November 26, 2019 on www.thecalgaryguide.com

Varicocele

Varicocele: Pathogenesis and clinical findings Authors: Luc Wittig Ryan Brenneis Reviewers: Alec Mitchell Darren Desantis* * MD at time of publication Notes: • 90% present as left sided. • Primary varicocele ache and scrotal venous distention can be relieved by superincumbent positioning (increases venous return). • Small varicoceles can be identified by preforming the Valsalva maneuver (decreases venous return). • Unilateral right varicoceles are uncommon and should be investigated for underlying pathology causing obstruction. Primary Anatomically: the left spermatic vein drains into the left renal vein Nutcracker Effect: The left renal vein can get pinched by the abdominal aorta and superior mesenteric artery Backup of blood in left renal vein ↑ pressure in left spermatic vein Secondary Renal cell carcinoma or retroperitoneal masses Inferior vena cava thrombus External compression of spermatic vein Obstruction of blood flow ↑ spermatic vein pressure Vein valve leaflet failure & retrograde bloodflow back towards testicle Dilation of pampiniform plexus and scrotal vein plexus Varicocele ↑ scrotal blood volume ↑ volume in a closed space ↑ pressure and distension of scrotal layers ↑ scrotal vein plexus pressure Compliant veins distend, becoming visible through scrotum Blood heats up the structures it flows through Scrotal hyperthermia Unsuitable environment for spermatogenesis Loss of germ cell mass Bag of Worms Sign Dull ache/heaviness Decreased fertility Testicular atrophy Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published November 26, 2019 on www.thecalgaryguide.com