)‫(دوالي الخصية‬

Def: engorgement of pampiniform plexus of veins in the scrotum

)ً‫توسع االوردة الي تأخذ الدم من الخصية والبربخ (احيانا ً ولكن مو دائما‬

Pampiniform plexus drains the testes and epididymis and is part of the spermatic cord

Common on the left side (90%) - WHY ?? ‫بنهاية الملخص تعرف ليش‬
Causes → idiopathic / absence or incompetence of valves in testicular veins /
obstruction of left testicular vein by tumor (in later life)

In some cases, the dilated veins are the cremasteric veins and are not part of
pampiniform plexus ً ‫لذلك كَلنا بالبداية مو دائما‬

Varicocele that does not decompress in supine position may indicate renal malignancy
(especially on the left side) ‫الدوالي اللي ما تنحل بوضعية االستلقاء (االنمطال ههههه) ممكن تدل على وجود ورم في‬
‫الكلية‬

Clinical features → asymptomatic (mostly)/symptoms appear in adolescence or

early adulthood / annoying dragging discomfort worse on standing / on exam feels
like a bag of worms ‫مثل جيس الدود‬
Diagnosis → US help in diagnosing small varicoceles / venous reflux on doppler
In older men and apparently recent onset of varicocele, US of kidney is IMPORTANT
to exclude left renal tumor

Treatment → operation is not indicated for Grading of varicocele

asymptomatic patients Grade 1 impalpable (seen only by

US)
if discomfort is significant → percutaneous embolization
)‫ما تنلزم (تشوفها بس بالسونار‬
of gonadal veins
Grade 2 palpable ‫تنلزم‬
if not useful or recurrence occur → surgical ligation of
Grade 3 visible ‫تنشاف بالعين‬
testicular veins
microsurgical subinguinal approach is the gold standard

Recurrence may occur even after surgery

Varicoceles are much more common (approximately 80-90%) in the left testicle
than in the right because of several anatomic factors, including the following:
- The angle at which the left testicular vein enters the left renal vein
)‫(الزاوية اللي يدخل بيها وريد الخصية االيسر لوريد الكلية تكون ضيقة وتسبب مقاومة عالية‬
- The lack of effective anti-reflux valves at the juncture of the testicular vein and
renal vein (‫(عدم او قلة وجود صمامات تمنع رجوع الدم بتقاطع وريدين الخصية والكلية من الجهة اليسرة‬
- The increased renal vein pressure due to its compression between the superior
mesenteric artery and the aorta
‫) وريد الكلية االيسر بين الشريان المساريقي العلوي والشريان االبهر‬ ‫انحصار (انجعاص‬

References
1) Bailey & Love's Short Practice of Surgery 27th Edition p1501-1502
2) Surgical Specialties (Board Review Series)
3) Varicocele: Practice Essentials, History of the Procedure, Problem
(medscape.com)
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