"Varicocele is rare in children under the age of ten years. However, it may be seen in up to 15–20% of adolescents and young men and as high as 42% in elderly men 7,8."
"Primary varicocele "
"post-vasectomy change"
"The common type of varicocele described in this article is also known as an extratesticular varicocele to differentiate it from the much rarer intratesticular varicocele."
"The left testis is affected much more commonly (≈85%) than the right and tends to be larger in bilateral cases. This is likely to be due to anatomical asymmetry, reflecting the shorter course of the right testicular vein and its oblique insertion into the inferior vena cava (IVC) which creates less backpressure. In contrast, the left testicular vein has a longer course and inserts into the left renal vein at a right angle, and the left renal vein is sometimes compressed between the aorta and SMA (nutcracker syndrome)."
"Secondary varicocele is much less common and results from increased pressure in the testicular vein due to compression (e.g. extrinsic mass such as retroperitoneal lymphadenopathy or renal mass, or renal vein compression in nutcracker syndrome 9), obstruction (e.g. renal vein thrombosis), or splenorenal shunting (portal hypertension)."
Expected headings
"Primary varicocele "
"Secondary varicocele"
"Variants"
"Classification"
"Clinically significant varicoceles are usually (~85%) left-sided and unilateral; bilateral varicoceles are present in ~10% of patients 10,11. Right-sided varicoceles are found in ~5% (range 1-8%) of patients and are usually not clinically significant 10,11."
"The change in vein diameter between supine and erect positions predicts impaired spermatogenesis; a threshold of >2.5 mm provides good diagnostic accuracy."
"Most varicoceles are primary and result from incompetent or congenitally absent valves in the testicular vein (internal spermatic vein). There is a familial tendency, with increased incidence in first degree relatives."
"There are numerous published varicocele grading or classification systems but none are universially accepted (c. 2021) 12. The Sarteschi classification is thought to be most clinically useful and is the most widely used (c. 2021) 11,12."
"Secondary varicocele is much less common and results from increased pressure in the testicular vein due to compression (e.g. extrinsic mass such as retroperitoneal lymphadenopathy or renal mass, or renal vein compression in nutcracker syndrome 9), obstruction (e.g. renal vein thrombosis), or splenorenal shunting (portal hypertension)."