Varicocelectomy Manuscript

General Santos Doctors’ Medical School Foundation, Inc.
Bulaong Subd., Brgy. West, General Santos City, Philippines

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CASE CONFERENCE
BILATERAL VARICOCELECTOMY
Submitted by:
Alimosa, Kylle
Campos, Lide Arna
Submitted to:
Mr. Vice Javellana, RN
September 9, 2023
Title: Bilateral Varicocelectomy

Population: BSN-3B SubGroup 3-A
Time Duration: 25 mins
Objective: To provide information about Bilateral Varicocelectomy
Specific Content Time Teachi Reference Evaluation
objectives allot ng
ment strateg
ies
Within 25 minutes Admitting Diagnosis: Varicocele bilateral After 25 minutes of
of lecture, the lecture, the BSN-
BSN-3B Definition: 3B SubGroup 3-A
SubGroup 3-A will - A procedure performed to remove varicoceles 1 Oral Hinkle, J., Cheever, K., & will be able to:
be able to: is called a varicocelectomy. The scrotal mins lecture 1. Define what
1. Define venous pampiniform plexus, which drains Overbaugh, K. (2022). is
what is blood from each testicle, abnormally enlarges varicocele &
varicocele and dilates. This condition is known as Brunner & Suddarth’s varicocelect
& varicocele. Varicoceles are the most often omy.ide
varicocelec found cause of aberrant semen analysis, Textbook of Medical- 2. Enumerate
tomy.ide reduced sperm count, impaired sperm signs and
2. Enumerate motility, and poor sperm morphology, while Surgical Nursing (15th symptoms.
signs and being typically painless and having clinical 3. Verbalize
symptoms. significance. ed., Vol. 2). Wolters understandi
3. Verbalize ng of the
understand Kluwer. anatomy &
ing of the physiology
anatomy & as well as
physiology its
as well as pathophysio
its Statistics: logy.
pathophysi 4. Enumerate
ology. - It is a well-recognized cause of decreased 1 min Oral Hinkle, J., Cheever, K., & medical &
4. Enumerate testicular function and occurs in lecture surgical
medical & approximately 15-20% of all males and in Overbaugh, K. (2022). manageme
surgical 40% of infertile males; the large majority nt.
manageme (95%) are in left testicle because incompetent Brunner & Suddarth’s 5. Identify
nt. valves are more common in the left internal nursing
5. Identify spermatic veins(Norris, 2019). Textbook of Medical- manageme
nursing nt.
manageme Surgical Nursing (15th
nt.
ed., Vol. 2). Wolters
Kluwer.
Signs and symptoms:
- Varicocele is often asymptomatic however,
when symptoms do manifest, they typically 1 min Oral Varicocele treatment. (n.d.).
feel like a dull aching or heaviness in the lecture
testicle that worsen during the day, especially & visual UCLA Health.
in hot temperatures or after strenuous activity. aid
The testicle is smaller on the varicocele side https://www.uclahealth.o
and the dilated veins in the scrotum are
frequently felt or seen. rg/medical-services/urol
ogy/varicocle-symptoms-
treatment-
diagnosis#:~:text=When
%20symptoms%20do
%20occur%2C
%20they,smaller%20on
%20the%20varicocele
Anatomy and Physiology:
%20side.
- The pampiniform plexus is a group of veins 5 Oral
into which blood from the testicle drains. mins. lecture Clavijo, R. I., Carrasquillo, R., &
Ergun et al. showed that the veins directly & visual
draining the testicle can be divided into two aid Ramasamy, R. (2017).
bundles, one of which is a collection of veins
tightly wrapped around the testicular artery, Varicoceles: prevalence
and the other in the nearby fatty tissue. They
did this by using cast preparations, light- and pathogenesis in
microscopic examination, and computer-aided
three-dimensional reconstruction. At the level adult men. Fertility and
of the internal inguinal ring, these two bundles
of veins eventually combine to form the Sterility, 108(3), 364–
internal spermatic vein. The main pathologic
mechanism for varicocele development is 369.
believed to be dilation of the internal
spermatic vein with blood reflux down into the https://doi.org/10.1016/j.f
pampiniform plexus. Rarely, external
compression of the ipsilateral renal vein or the ertnstert.2017.06.036
spermatic vein itself might cause varicoceles
by preventing testicular venous drainage.

Dilation and reflux are two symptoms of
primary varicocele, which can be brought on
by a variety of reasons. First, the frequency of
left-sided varicoceles and the dearth of
clinically perceptible bilateral and isolated
right-sided varicoceles may be explained by
the fact that the left and occasionally the right
internal spermatic veins drain into the renal
vein perpendicularly. The formation of
varicoceles may be explained by this drainage
pattern, the longer total drainage tract, and
the larger venous pressure variations.
Second, varicoceles are thought to arise as a
result of ineffective venous valves and
variations in internal spermatic vein drainage.
Early investigations in males on postmortem
exams showed that internal spermatic vein
valves were ineffective or absent in 50% of
the men investigated. Recent investigations,
especially those involving teens, have
demonstrated that patients with varicoceles
either have no valves at all or have ineffective
valves.
Third, constriction of the left renal vein or
internal spermatic vein is a rather uncommon
mechanism for varicocele development.
Internal spermatic vein insufficiency has
traditionally been attributed to the nutcracker

syndrome, in which the renal vein is squeezed
between the aorta and superior mesenteric
artery. Abdominal imaging is indicated for
older men who have isolated right-sided
varicoceles and perhaps new left-sided
varicoceles.
The iliac vein is the destination of
extrafunicular veins, which include the
cremasteric, external pudendal, gubernacular,
and deferential veins. Although it is
recommended to leave the deferential veins
alone after varicocelectomy, it is debatable
whether or not to ligate the remaining
extrafunicular veins. It is quite improbable that
the extrafunicular veins cause pathogenic
initial or recurrent varicoceles, according to
the findings from venography. To close this
pathologic venous circuit, some extrafunicular
veins may be tied up. Clinically, delivering the
testis and attempting to ligate all
extrafunicular veins, save for the deferential
vein, has no positive effect on hormonal and
semen parameters.
10 Oral
mins lecture
& visual
Pathophysiology: aid Clavijo, R. I., Carrasquillo, R., &

Even in those who are not seeking treatment for
infertility, the kind of sperm known as varicoceles is Ramasamy, R. (2017).
linked to poor semen parameters. The majority of
conceivable pathways, however, have been derived Varicoceles: prevalence
from nonhuman models since no one hypothesis
firmly explains how varicoceles directly alter and pathogenesis in
spermatogenesis. Oxidative stress, local hormonal
imbalances, blood stasis (toxin buildup), testicular adult men. Fertility and
hypoperfusion, and heat stress are some of the
pathologic causes examined. Sterility, 108(3), 364–
Oxidative stress is a consequence of metabolic
processes that harm spermatogenesis, such as 369.
mitochondrial respiration. diminished sperm motility,
aberrant sperm morphology, and diminished sperm https://doi.org/10.1016/j.f
adenosine triphosphate (ATP) generation have all
been linked to excessive ROS production. Patients ertnstert.2017.06.036
seeking treatment for infertility who have varicoceles
tend to have greater ROS levels in their semen,
which can cause DNA fragmentation and reduce
reproductive potential.
Histological evidence that this syndrome causes
blood to stagnate in microcirculatory arteries,
resulting in ischemic structural alterations at the
cellular level, includes testicular hypoperfusion and
stasis of blood (toxin buildup). At the molecular level,
evidence of hypoxia in males with varicoceles has
been examined; one research found a greater
expression of hypoxia-inducible factor 1 in samples
from internal spermatic veins. The idea that
varicoceles reduce local blood flow in the testicle is

supported by studies showing better testicular artery
hemodynamics following varicocelectomy.
Studies have found a considerably higher
intratesticular and scrotal skin temperature linked
with varicoceles, providing strong evidence that
scrotal hyperthermia impairs spermatogenesis. The
Dahl et al. model of scrotal countercurrent heat
exchange, which states that heat is transferred
above the testicle between arteries supplying blood
to the testicle and vessels departing the testicle, is
the basis for theories on how varicoceles raise
testicular temperature.
Hypogonadism and slowed spermatogenesis have
both been related to varicoceles, a hereditary
condition that impairs the quantity and functionality
of Leydig cells in the testis. Repairing varicoceles
can reverse symptomatic hypogonadism and poor
spermatogenesis by bringing blood androgen levels
back to normal. Testicular function is temperature-
dependent, and the Leydig cell population that
maintains the proper testosterone levels required for
spermatogenesis may be negatively impacted by
pathogenic processes of varicoceles, such as toxin
buildup, heat stress, and oxidative stress.
Leydig cells, which provide 95% of adult men's total
serum testosterone output, are the main androgen-
producing cells in mammals. The pituitary gland
straight stimulates Leydig cells in a five-step
enzymatic process, which results in the production of
testosterone. As a rate-limiting step in the production

of testosterone, steroidogenic acute regulatory
protein (StAR) facilitates the trafficking of cholesterol
precursor from the cytoplasm to mitochondria
through this route. Studies conducted in vitro have
shown that oxidative stress inhibits the production
and function of the StAR protein.
Varicocele causes heat stress to the testes, which
inhibits testicular function. Nonhuman research have
shown that heat stress has a direct detrimental effect
on the survival of Leydig cells and testosterone
synthesis. The unfolded protein response, an
intracellular cascade that enables detection of heat-
induced protein misfolding and subsequent
destruction, is activated by the endoplasmic
reticulum, an organelle crucial to preserving cellular
homeostasis under stress. The proapoptotic
mechanisms that cause cell death can also be
activated by prolonged heat exposure.
In addition to being common, varicoceles are also

pathogenic, which affects the semen parameters and
testosterone production. For appropriate treatment
choices, particularly if embolization or high ligation of
the internal spermatic vein is chosen, it is essential
to understand the anatomy of varicoceles,
particularly the variety of venous drainage pathways.
Understanding the architecture and process by
which varicocele affects testicular function is crucial
for doctors to select the best treatment choice and to

explore the causes of recurrence and problems
when counseling patients, even if some reasonable
explanations remain unsubstantiated.
1 min Oral
Laboratory studies: lecture
- Confirmation of the diagnosis is facilitated by & visual
a blood test, ultrasound, and semen analysis. aid
An ultrasound provides a more thorough
image of the testicular veins. If a varicocele White, W. M., MD. (n.d.-a).
impairs fertility, it can be determined with a
blood test and semen analysis. Varicocele: practice
essentials, history of the
procedure, problem.
https://emedicine.medsc
ape.com/article/438591-
Medical management: 2 Oral
- An anatomical anomaly called a varicocele mins lecture overview
can affect sperm function and production. & visual
There are currently no proven medical aid
management for varicoceles. However, the
use of nutritional supplements, such as White, W. M., MD. (n.d.-a).
vitamins A, E, C, and B complex, glutathione,
pantothenic acid, coenzyme Q10, carnitine, Varicocele: practice
and micronutrients including zinc, selenium,
and copper, is supported by some research. essentials, history of the

These might raise antioxidant enzyme levels
and lower inflammatory marker levels. procedure, problem.
Varicocele, which impairs Leydig cell activity,
can exacerbate the aging-related decline in https://emedicine.medsc
testosterone synthesis in older men, leading
to hypogonadism. These individuals, who are ape.com/article/438591-
unlikely to be concerned about fertility, may
benefit from testosterone replacement overview
medication.
Surgical management: 2 Oral

mins lecture
Types of varicocelectomy surgery include the & visual
following: aid
Professional, C. C. M. (n.d.).
- Open varicocelectomy, a procedure requiring an
open incision. The following categories of surgery Varicocelectomy.
may be made based on where the incision is made.
- Retroperitoneal high ligation, in which the lower Cleveland Clinic.
abdomen is cut
https://my.clevelandclinic
- Inguinal ligature, Access to the varicocele through
the inguinal canal will be possible. The inguinal canal .org/health/treatments/2
is located in the groin, close to the abdomen's lowest
point. 4234-varicocelectomy
- Sub-inguinal ligation The groin is where the incision
is made for inguinal and sub-inguinal ligation.
- Laparoscopic varicocelectomy, which makes use of

a laparoscope, a telescope-like device.
- Microsurgical varicocelectomy, performed with the
use of a microscope and microscopic instruments for
surgery.
Nursing management:
Post-op
- Apply ice pack to the scrotum for the first few 1 min Oral
hours after the surgery to relieve edema. lecture
- Dressing can be removed after 48 hours. & visual
- Educate the patient to do only non-strenuous aid
exercise for the first 2 days and use a scrotal
support.
- Inform the patient to take the pain relievers Hinkle, J., Cheever, K., &
that is prescribed by the physician.
- Inform the patient to report for complications Overbaugh, K. (2022).
such as infection or hematoma.
Brunner & Suddarth’s
Textbook of Medical-
Prognosis: Surgical Nursing (15th

- 60-70% of patients after varicocelectomy had
better quantity semen characteristics, and 40- 1 min Oral ed., Vol. 2). Wolters
60% of patients have enhanced conception lecture
rates. & visual Kluwer.
aid
White, W. M., MD. (n.d.-c).
Varicocele treatment &
management: medical
therapy, surgical
therapy, preoperative
details.
https://emedicine.medsc
ape.com/article/438591-
treatment

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General Santos Doctors’ Medical School Foundation, Inc.

Bulaong Subd., Brgy. West, General Santos City, Philippines

Title: Bilateral Varicocelectomy

by preventing testicular venous drainage.

traditionally been attributed to the nutcracker

Pathophysiology: aid Clavijo, R. I., Carrasquillo, R., &

varicoceles reduce local blood flow in the testicle is

testosterone. As a rate-limiting step in the production

In addition to being common, varicoceles are also

for doctors to select the best treatment choice and to

essentials, history of the

and copper, is supported by some research. essentials, history of the

Surgical management: 2 Oral

- Laparoscopic varicocelectomy, which makes use of

Prognosis: Surgical Nursing (15th

White, W. M., MD. (n.d.-c).

Varicocele treatment &

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