A varicose enlargement of the veins of the spermatic cord, epididymis
and testicle. In varicocele the pampiniform plexus is usually enlarged,
but all the veins of the cord may be involved. The swelling gets
smaller under compression or in a horizontal position and enlarges
again on standing erect. It is almost invariably found on the left
side, and the testicle on the affected side is generally smaller and
softer than its fellow.
The predisposing =causes= are a longer and tortuous spermatic vein on
the left side; the absence of support of the veins from surrounding
muscles; the imperfect valves; the entry of the left spermatic vein
into the renal vein at a right angle, instead of at an acute angle like
the right vein; the more liability of compression of the left spermatic
vein by accumulation of feces in the sigmoid flexure; the lack of
normal exercise of the sexual functions in young, unmarried adults.
Lesions in lower dorsal and upper lumbar affect the condition; the
eleventh dorsal particularly. A lesion at the second lumbar may cause
neuralgia of the testicle with engorgement of the vein.
The exciting causes are straining during stool, heavy lifting,
excessive sexual indulgence or anything that would determine more blood
to the testicles. Varicocele is similar to the varicose state of the
hemorrhoidal veins and may have like causes.
The =diagnosis= is easily made. The feeling of the veins between the
fingers like a convolution of earth worms; dull, aching, dragging
sensation, and possibly prostration, weakness and dejectedness of
spirits, are characteristic symptoms. “The condition is devoid of
danger, except that it often begets morbid fears on the part of the
patient, usually the result of suggestion.”[49]
The =treatment= consists of regulation of the bowels, removal of such
predisposing and exciting causes as may be found, treatment of the
vessels along the spermatic cord, and treatment to the lower dorsal
and lumbar regions. In severe cases a suspensory bandage will give
temporary relief. Surgical interference may be necessary in some cases
in order to effect a cure.