Why does idiopathic varicocele occur predominantly on the left side?
- A The left internal spermatic vein drains into the left renal vein at a right angle ✓
- B The left testicular vein is shorter than the right
- C The right internal spermatic vein drains directly into the vena cava against gravity
- D The left cremasteric pump is weaker than the right
Correct answer: A. The left internal spermatic vein drains into the left renal vein at a right angle
Explanation
The left internal spermatic vein enters the left renal vein almost at a right angle while the right vein joins the inferior vena cava obliquely in a valveless but lower pressure system. This produces higher hydrostatic pressure and reflux on the left, explaining the 90% left predominance. A sudden new right-sided or bilateral varicocele in an older man should raise suspicion of an abdominal malignancy obstructing the renal vein, classically renal cell carcinoma.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.