Varicocoele

• Acute onset often due to left renal vein compression from renal cell tumour
• More common on the left
• Associated with oligospermia

Indications

1. Male infertility
2. Scrotal discomfort

Treatment options

1. Radiological embolisation
2. Laproscopic division of varicocole from within peritoneal cavity
3. Surgical approach at level of internal ring

Surgical Procedure

1. GA + supine
2. Dissect down to testicular vein
   • Make incision over internal ring parallel to inguinal ligament
   • Divide external oblique aponeurosis, visualise cord and split spermatic fascia longitudinally to expose testicular veins (from pampiniform plexus)
3. Isolate and divide vein
   • Separate vein from vas and testicular artery
   • Ligate and divide with absorbable sutures
4. Close
   • Repair external oblique aponeurosis with absorbable subcuticular suture
   • close skin incision with subcuticular non-absorbable suture