A isolated right sides varicocele

Someone asked me this the other day: can an isolated right sides varicocele be a sign of something bad?

Yes it can be caused by a large right sided renal mass, at least according to the textbooks, because in practice--since 2000--I have never seen an isolated right varicocele be associated with a renal mass.

But here is why it can happen:

• On the left side, the testicular vein drains into the left renal vein.  The insertion of the testicular vein into the renal vein forms right angle and blood backs up.  When venous blood backs up, varicose veins form.  Varicoceles are varicose veins of the testicle.
• On the right side, the right testicular vein drains directly into the vena cava, which is the bodies largest vein.  Blood rarely ever backs up here, but if the vein is occluded, say from a large renal cancer, it can.  In this case, the man would develop an isolated right varicocele.

Bilateral varicoceles are common and not associated with kidney cancer.

Disclaimer:  this post is meant to be educational only.  It does not indicate or imply that any medical advice is being given.  No doctor-patient relationship exists.  If the reader is concerned, seek the advice of a doctor. 

Absence of the vas deferens

The vas deferens is the muscular tube that transports sperm from the testicle to the urethra and ultimately to its target destination.  Most have have 2 of them, one for on the right and one on the left side.  But some men have only one vas and some are missing both.  This condition is known as congenital absence of the vas deferens.  It is uncommon, but I see 2 cases per year, at least, in my busy male infertility practice.

Most men with only one absent vas never know what they are missing.  They are fertile.  In these men, the discovery is made when the man goes to the urologist for a physical exam, say before a vasectomy.
Men with 2 missing vasa (plural of vas), are infertile.  Actually, this is not true.  They are very fertile, only the sperm cannot get out of the epididymis and testicle.  In order for these men to impregnate a partner, they sperm must be retrieved surgically.   This can be done quite easily, in about 5 minutes actually, and that terrifically healthy sperm can then be used with IVF or ICSI.  This sperm retrieval procedure is called "a sperm retrieval." 

The sperm can be harvested from either the epidiymis or testicle or both.  The procedure can be done in the office, underl local anesthetic, with a very skinny needle, and is successful ~99% of the time. 

About 10% of men with a missing vas deferens will have a missing kidney as well.  This happens because the kidney, ureter, and vas deferens all form at the same time in-utero--or when the baby is in the womb--and all come from something called the wolfian duct.  No patient would ever need to know this, but I find it interesting.  When I diagnose a man with a missing vas deferens, I order a renal sonogram.  People like to know if they have one or two kidneys.

That's it..