Varicose veins of the spermatic cord

Varicose veins of the spermatic cord occur in men aged 20-30 years, usually on the left. On the left, the testicular vein flows into the renal at a right angle (on the right, it flows into the inferior vena cava); the lower location of the left testicle matters. Secondary (symptomatic) varicocele may be due to stenosis of the renal vein by a kidney tumor. Bilateral involvement is due to primary failure of the testicular vein valves and/or the presence of arteriovenous anastomoses.

Symptoms and course

Feeling of heaviness, pain in the testicle, scrotum, along the spermatic cord, aggravated by physical exertion and long standing. On palpation of the scrotum, convoluted veins of the spermatic cord (“ball of worms”) are determined, sometimes a small hydrocele on the side of the lesion. The course of the disease is gradually progressive. With the normalization of sexual life, a regression of symptoms is noted. The appearance of varicocele in the elderly is more characteristic of the symptomatic genesis of the disease.

Stages of the disease

Stage I – there are no subjective sensations, dilated veins are localized within the spermatic cord;

Stage II – the veins are dilated to the lower pole of the testicle, heaviness and pain in the testicle, the spermatic cord is thickened;

Stage III – dilated veins at the bottom of the scrotum below the testicle, which may be atrophied; pain in the testicle, perineum, lumbar region, sacrum.


With a pronounced pain syndrome, surgical treatment is indicated: an incision parallel to the inguinal canal extraperitoneally isolate and ligate the testicular vein (Ivanissevin’s operation). As conservative measures, wearing a suspensory, tight shorts or swimming trunks, normalization of sexual life is shown. The prognosis is favorable.

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