Varicocele – colloquially called varicocele hernia – (synonyms: Testicular varicocele; Varicocele testis; Varicocele of the pampiniform plexus; ICD-10-GM I86.1: Scrotum varices, varicocele) refers to varicose vein formation in the area of the pampiniform plexus formed by the testicular and epididymal veins.
A high percentage (75-90%) of varicocele cases are left-sided.
The following forms of varicocele are distinguished:
- Primary varicocele/idiopathic varicocele – congenital form (almost right-angled confluence of the testicular vein with the renal vein on the left side combined with insufficient venous valves → long, hydrostatic pressure column → decompensation, i.e. varicose vein formation in the area of the pampiniform plexus formed by the testicular and epididymal veins.
- Secondary varicocele/symptomatic varicocele – arises due to outflow obstruction caused by retroperitoneal space (e.g., due to tumor disease); nutcracker syndrome: compression of the V. renalis sinistra between the A. mesenterica sup. and the aorta
Frequency peak: varicocele occurs in adolescence (period of life between late childhood and adulthood) and adulthood.
The prevalence (disease incidence) is 8-10%. With adolescence – especially during puberty – there is an increase in incidence. This is due to increasing body size and the resulting increase in hydrostatic pressure in the testicular vein.
Course and prognosis: The varicocele is usually asymptomatic. When standing, some patients complain of pain.Varicocele can lead to subfertility (reduced fertility). In men with a pathological spermiogram, a varicocele is present in about 25% of cases.An indication for varicocelectomy (surgical removal of the varicocele; see “Surgical therapy” below) exists if, in addition to the varicocele, a reduced testicle is also present. If there is pain, as well as for cosmetic reasons, there is also an indication for surgery.
