varicocele
Dr. hassanain ahmed AL bayati
D.M.R.D;DIAGNOSTIC RADIOLOGY
F.I.B.M.S Rad
Lecture in department of radiology
Babylon university college of medicine
varicocele
The pampiniform plexus is a network of many small
veins found in the human male spermatic cord. It is
formed by the union of multiple spermatic veins from the
back of the testis and tributaries from the epididymis.
The veins of the plexus ascend along the cord in front of
the ductus deferens. Below the subcutaneous inguinal
ring they unite to form three or four veins, which pass
along the inguinal canal, and, entering the abdomen
through the abdominal inguinal ring, coalesce to form
two veins. These again unite to form a single vein, the
testicular vein, which opens on the right side into the
inferior vena cava, at an acute angle, and on the
left side into the left renal vein, at a right angle
The pampiniform plexus is a network of many small veins found in the human male spermatic cord. It is formed by the union of multiple spermatic veins from the back of the testis and tributaries from the epididymis.The veins of the plexus ascend along the cord in front of the ductus deferens. Below the subcutaneous inguinal ring they unite to form three or four veins, which pass along the inguinal canal, and, entering the abdomen through the abdominal inguinal ring, coalesce to form two veins. These again unite to form a single vein, the testicular vein, which opens on the right side into the inferior vena cava, at an acute angle, and on the left side into the left renal vein, at a right angle
component of pampiniform plexus ;
A- internal spermatic vein ( ventral location ) draining testis
B- vein of vas deferens ( mediodorsal location )draining epidedymis
C- cremasteric vein ( laterodorsal location )
A- internal spermatic vein ( ventral location ) draining testis B- vein of vas deferens ( mediodorsal location )draining epidedymis C- cremasteric vein ( laterodorsal location )
Varicoceles defines as a result of
dilatation and tortuosity of veins of
the pampiniform plexus may be
secondary to retrograde flow into
the internal spermatic vein (ISV).
US is almost specific & sensitive in 100%
grading of varicocele
Normal 2.2mm to after valsalva 2.7mm
2.5mm to 4mm after valsalva up to 1mm
4mm to mm after valsalva up to 1.2-1.5
More than 5mm after valsalva up to 1.5mm
Normal 2.2mm to after valsalva 2.7mm2.5mm to 4mm after valsalva up to 1mm4mm to mm after valsalva up to 1.2-1.5More than 5mm after valsalva up to 1.5mm
incidence
Clinical varicocele in 8-15 % in adult male
& 21 -39 of infertile male
Sub clinical varicocele ; 40-75% of infertile men
Reffrence ; radiology review manual 6th edition by wolfgang dahnert volume 2
idiopathic causes
Absent valve at the level of left renal vein
Absent valve at the level of IVC
A varicocele
is a common abnormality,
occurring in approximately 15% of men.
Some patients may have scrotal pain and
swelling, but more importantly, a varicocele
is considered to be a potential cause of male infertility.1, 2, 3
This relationship is controversial, but improved fertility
and sperm quality have been reported after surgical correction ,
including occlusive treatment for varicoceles. On physical examination
, large varicoceles are easily identified as the
classic "bag of worms" surrounding the testis
Venous hypertension in the spermatic
cord veins may be responsible for the
aforementioned effects on the testis.
The size of the varicoceles may not be
a key predictor of infertility in that
size seems to have no relationship to
improvement in spermatogenesis after corrective surgery.9
In all probability, subclinical
varicoceles may be responsible
for the vast majority of cases of male
infertility
reference KM, Prasad K, Szmigielski W,
Noorani N. Intratesticular varicocele:
evaluation using conventional and Doppler sonography.
AJR Am J Roentgenol. Oct 1999;173(4):1079-83. [Medline]. [Full Text].
Doppler ultrasonography,
2 types of retrograde flow in varicoceles have been described
shunt-type varicocele and the stop-type
varicocele (see Image below ). The
shunt-type varicocele occurs in 86% of
patients and is associated with
diminished sperm quality as well as with
a medium to large varicocele
stop-type varicocele involves reflux,
which is only brief, and the sperm
quality is normal and associated
with a subclinical varicocele.
Shunt-type Doppler flow occurs because
insufficient distal valves allow spontaneous
and continuous reflux from the internal
spermatic vein into the cremasteric vein and
the vein of the vas deferens via collateral vessels
.
The stop type of flow, also known as the
pressure type, occurs in patients with
intact intrascrotal valves. This type allows
only a brief period of reflux from the
spermatic vein into the pampiniform
plexus when a Valsalva maneuver is performed
Media file 6: Line diagram of
a typical bidirectional Doppler
recording of a stop-type varicocele
(red) in which flow is stopped by
a competent valve in the pampiniform
plexus above the level of communicating veins.
The shunt-type of varicocele is depicted in blue.
Because the valves in the pampiniform plexus
contiguous to the testicular veins are incompetent
or absent, venous flow is shunted via communicating
veins into orthograde draining veins; these are shown
to represent deferential and cremasteric veins at
contrast venography. On bidirectional Doppler sonograms,
steady flow is recorded in both retrograde and orthograde fashions.
Note:
Several factors affect the flow, including
A-The position of the patient,
b- Valsalva maneuvers,
seem diagram in pdf with ;
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .