A 22-year-old man being evaluated for primary subfertility is found to have a scrotal swelling that feels like a bag of worms, more prominent on standing and disappearing on lying down. Why does this condition occur predominantly on the left side?

• A The left internal spermatic vein drains into the inferior vena cava at a right angle
• B The left cremasteric pump is weaker than the right
• C The left testicular artery compresses the pampiniform plexus
• D The left internal spermatic vein drains into the left renal vein at a right angle ✓

Explanation

Varicocele is commoner on the left because the left internal spermatic vein enters the left renal vein almost at a right angle, whereas the right vein drains obliquely directly into the inferior vena cava. This creates a longer column of blood with higher hydrostatic pressure on the left. A new right-sided varicocele in an adult should prompt imaging for renal tumour or other causes of inferior vena caval or renal vein obstruction. Varicocele is a correctable cause of male infertility through improved spermatogenesis.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.