Varicocele: veins that wake up with Valsalva

Question 1Why are most varicoceles on the left?

1. aPatients lie on their left side
2. bThe left testis is larger
3. cThe left testicular vein drains at a right angle into the left renal vein
4. dThe right side has no veins

Question 2Which manoeuvre makes a varicocele easier to see?

1. aCooling the scrotum
2. bLying flat and breathing quietly
3. cPressing hard with the probe
4. dValsalva or standing

Question 3About what vein size supports a varicocele?

1. aSize is never measured
2. bUnder 1 mm
3. cOver about 3 mm, enlarging on Valsalva
4. dExactly 10 mm

Question 4A man has a new right-sided varicocele that does not empty lying down. What next?

1. aUrgent scrotal exploration
2. bReassure and discharge
3. cRepeat the scan in a year
4. dImaging of the abdomen and kidneys for a mass pressing on the veins

Question 5Why compare the size of both testes?

1. aTo exclude appendicitis
2. bIt is not useful
3. cTo measure blood pressure
4. dA smaller testis on the varicocele side matters for referral