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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
In adults, renal cancer is known as renal carcinoma, renal cell carcinoma or hypernephroma. It spreads locally or via the lymphatic system to the renal hilum, retroperitoneum and para-aortic lymph nodes and often invades the renal veins and inferior vena cava. The left testicular vein drains into the left renal vein, so blockage of this vein by tumour can cause a left-sided varicocoele (dilated varicose vessels in the scrotum). Metastases typically arise in the lungs, liver, bones and brain.
Varicocele
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Taha Abo-Almagd Abdel-Meguid Hamoda
Varicocele formation has traditionally been believed to result from defective venous valvular mechanisms in many subjects. Ahlberg et al. studies [17,18] have shown completely absent or dysfunctional valves within the internal spermatic (testicular) veins of many subjects, which was more prevalent in the left side as compared to the right side. The last finding may help explain the preponderance of left sided varicoceles. Shafik and Bedei [19] have clarified other anatomic considerations to help identify the reasons of varicocele formation and the left-sided preponderance. Whereas the right testicular vein is a direct oblique tributary of the inferior vena cava (IVC) shielding the right testicular vein from the caval pressure, the left testicular vein drains into the left renal vein in a perpendicular fashion. Such anatomic configuration results in an approximately 8–10 cm longer left testicular vein and exposes the left testicular vein to the higher renal vein pressure. The ensuing increased left testicular vein hydrostatic pressure may defeat the valvular competency and lead to varicocele formation in some individuals. The compressed left renal vein between the superior mesenteric artery and abdominal aorta can also lead to left varicocele formation (nutcracker effect).
The abdominal wall and inguinoscrotal conditions
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
A varicocele is enlargement of the veins of the pampiniform plexus in the spermatic cord, and almost always involves the left side and develops around the time of puberty. There may be little abnormality to observe when the adolescent is supine apart from an asymmetrical scrotum (with the left side redundant), but on standing the veins fill and become visible, and feel like ‘a bag of worms’. A small secondary hydrocele may be observed. Varicoceles are usually symptomless, although some boys complain of a dragging ache or discomfort in the groin. If untreated, the left testis may not grow as much as the right testis at puberty, a reflection of the effect on spermatogenesis of unilateral warming of the testis by the surrounding veins. Uncommonly, a varicocele may develop from obstruction of one of the renal veins by a renal or perirenal tumour, of which Wilms tumour and neuroblastoma are the most common. Because the left testicular vein drains directly into the left renal vein, this sign is seen almost always on the left side. Consequently, an underlying cause must be suspected in a boy under 6 years of age who develops a varicocele; the tumour will usually be palpable as an abdominal mass.
The prevalence and severity of varicocele in adult population over the age of forty years old: a cross-sectional study
Published in The Aging Male, 2019
Huseyin Besiroglu, Alper Otunctemur, Murat Dursun, Emin Ozbek
Varicocele is an abnormal dilatation of internal spermatic veins within the pampiniform plexus. Varicoceles are a frequent scrotal finding in normal males. Although the pathogenesis and natural history remain controversial, varicocele is thought to contribute to the risk of infertility in men. Furthermore, two population-based studies indicate that 85% of men with varicocele have fathered children suggesting that its effect on paternity is less clear [1,2]. The underlying pathologic process is not well known, but varicoceles have been associated with turbulent venous flow related to the right angle insertion of the left testicular vein into the left renal vein, which could be an explanation why left-sided varicocele is observed more frequently. In addition, the nutcracker phenomenon, defined as the compression of the left renal vein between superior mesenteric artery and aorta, may contribute to the pathogenesis of varicocele [3,4].
Conservative treatment of partial testicular artery injury during transabdominal preperitoneal hernioplasty (TAPP)
Published in Acta Chirurgica Belgica, 2022
Goran Augustin, Lucija Brkic, Maja Hrabak Paar
With the TAPP inguinal hernioplasty, vascular injuries are possible at multiple operational steps. Injury may occur with the introduction of the Veress needle, the first trocar insertion, and during insertion of other trocars. During dissection of the preperitoneal space and the hernia sac, injuries to deep inferior epigastric arteries, testicular arteries, deferential arteries, and both external iliac arteries and veins are possible. All these vascular injuries are can occur during the mesh and peritoneum fixation with tacks. In our case, after TAPP, bilateral retroperitoneal hematoma developed. CT showed that both deep inferior epigastric arteries and right testicular artery had a normal flow up to periphery. The contrast of the left testicular artery was visible up to the hematoma, but without active extravasation. A left testicular vein was visible up to the left renal vein. The assumption was that the most likely cause of bleeding is a small injury of the left testicular artery, which did not actively bleed intraoperatively due to stretch from manipulation, raised intraabdominal pressure, and reflex vasoconstriction. Postoperatively, a large hematoma possibly compressed the injured artery resulting in cessation of extravasation. Another exclusion of the testicular vein injury is that it would not result in such a massive hematoma. Iatrogenic injury of the testicular artery is very rare and is most commonly encountered during orchiectomy [6]. With such injuries, the vitality of the testis could be an issue. These represent high testicular artery injuries and other uninjured arteries contributing to testicular blood supply are sufficient for adequate testicular perfusion.