Relevant Anatomy
The testes are the paired male genital organs
that contain sperm, cells that produce and nourish sperm (spermatogonia and
Sertoli cells, respectively), and cells that produce testosterone (Leydig
cells). The testes are located in a sac called the scrotum. The epididymis is a
small tubular structure attached to the testes that serves as a storage
reservoir wherein sperm mature.
Sperm travel through the vas deferens, which
connects the epididymis to the prostate gland. The vas deferens is in the
scrotum and is part of a larger tissue bundle called the spermatic cord. The
spermatic cord contains the vas deferens, blood vessels, nerves, and lymphatic
channels.
The pampiniform plexus is composed of the
veins of the spermatic cord. These veins drain blood from the testes,
epididymis, and vas deferens and eventually become the spermatic veins that
drain into the main circulation of the kidneys. The pampiniform venous plexus
may become tortuous and dilated, much like a varicose vein in the leg. In fact,
a scrotal varicocele is simply a varicose enlargement of the pampiniform plexus
above and around the testicle. Two other veins, the cremasteric and the deferential,
also drain blood from the testicles; however, they are rarely involved in the
varicocele process.
The image below illustrates the basic anatomy.
A large varicocele is seen through the scrotal
skin. In a patient with a varicocele, the dilated vessels of the pampiniform
plexus are easily appreciated within the scrotum.
Contraindications
Opinions vary regarding the value of
repairing subclinical varicoceles in infertile men, but most experts do not
recommend it. In addition, discovery of a varicocele at the time of vasectomy
or vasectomy reversal is a relative contraindication to
immediate repair. A 6-month delayed repair is recommended to allow the
development of collateral vessels in order to decrease the chance of vascular
compromise to the testicle.
