The veins of the testis and epididymis form a pampiniform plexus within the spermatic cord, which ascends and converges into several branches of the internal and external spermatic veins at the inguinal canal. In about 60% of individuals, the internal spermatic vein converges into a single branch at the internal ring; in a few cases, it remains as two or three branches. These veins ascend through the retroperitoneal space. On the right side, they enter the inferior vena cava at an oblique angle, while on the left side, they enter the left renal vein at a right angle. Due to the longer course of the left internal spermatic vein and the higher resistance caused by the right-angle entry into the renal vein, the vein passes behind the sigmoid colon and is compressed by this segment of the bowel. Combined with the lack of venous valves and the absence of surrounding muscle compression, the left internal spermatic vein experiences reflux. When standing, there is a considerable column of blood pressure acting downward on the pampiniform plexus, causing it to dilate and enlarge, resulting in varicocele of the spermatic vein. This condition can also occur due to tumors in the posterior abdominal wall or kidney compressing the veins, leading to venous reflux, which is also manifested as varicocele. To differentiate from the former, the latter is called secondary varicocele of the spermatic vein, while the former is called primary varicocele of the spermatic vein. The main distinguishing feature is that the primary varicocele of the spermatic vein disappears quickly when lying down, whereas the secondary one does not disappear or disappears very slowly.
Clinical Manifestations:
Patients may be completely asymptomatic. If symptoms are present, they usually involve a feeling of heaviness in the scrotum after prolonged standing, which can radiate to the same side lower abdomen or inner thigh. Lying down alleviates these symptoms. Recent reports indicate that patients with varicocele of the spermatic vein have reduced sperm count, affecting fertility. Surgical treatment can restore fertility. Additionally, some patients experience restlessness, anxiety, insomnia, general weakness, and erectile dysfunction. Severe varicocele of the spermatic vein can lead to atrophy of the affected testicle, prompting patients to seek medical attention due to a smaller testicle size.
Varicocele of the spermatic vein is a common urological disease in males, affecting approximately 10% of young men. Since it is also a major cause of male infertility, the medical community recommends that young unmarried men who discover varicocele should not ignore it but should undergo regular follow-up examinations, with severe cases requiring early surgical treatment. Varicocele of the spermatic vein refers to abnormal swelling of the male spermatic veins, occurring in 90% of cases on the left side, with bilateral occurrence in 10% of patients, and very few cases occurring solely on the right side.