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Introduction

A varicocele is a common condition characterized by abnormal dilation of veins within the scrotum.  It typically presents in adolescents and young adults as a soft, irregular mass directly above the testis that may feel like a "bag of worms."  The mass typically increases in size with standing or Valsalva maneuver and decreases with recumbency.  Patients are often asymptomatic, but some experience a dull scrotal ache after prolonged standing or exertion.

The diagnosis is usually made clinically but can be confirmed with scrotal ultrasonography.  Most cases are managed with reassurance and observation.  However, a varicocele can impair fertility, and surgical repair may be necessary to preserve reproductive function.

Pathophysiology

A varicocele results from dilation of the pampiniform plexus, a network of veins that drain blood from the testicles.  It occurs more commonly on the left side due to anatomical differences in the left and right spermatic (gonadal) veins (

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