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Varicocele

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
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Last reviewed: 21 Oct 2024
Last updated: 26 Jul 2024

Summary

Definition

History and exam

Key diagnostic factors

  • painless scrotal mass
  • left-sided signs/symptoms
  • small testicle
Full details

Other diagnostic factors

  • infertility
  • age >12
  • scrotal or groin pain
Full details

Risk factors

  • somatometric parameters (tall/low BMI)
  • family history of varicocele
Full details
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Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • scrotal ultrasound with color flow Doppler imaging
  • semen analysis
  • serum FSH (± GnRH stimulation)
  • serum testosterone
  • DNA fragmentation index (DFI)
  • CT abdomen/pelvis
  • MRI abdomen/pelvis
  • retroperitoneal ultrasound
Full details
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Treatment algorithm

ACUTE

adolescent

adult

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Contributors

Authors

Jay Ira Sandlow, MD

Professor and Chair

Department of Urology

Medical College of Wisconsin

Milwaukee

WI

Disclosures

JIS declares that he has received stock options as a member of the Scientific Advisory Board for Contraline, Inc. and has served as a faculty member on the Vasectomy course for the American Urological Association.

Daniel L. Pelzman, MD

Fellow in Male Reproductive and Sexual Health

Department of Urology

Medical College of Wisconsin

Milwaukee

WI

Disclosures

DLP declares that he has no competing interests.

Acknowledgements

Dr Jay Ira Sandlow and Dr Daniel L. Pelzman would like to gratefully acknowledge Dr Jagan K. Kansal, Dr Pravin Rao, Dr Miguel Pineda, Dr John C. Thomas, and Dr Wayne Kuang, previous contributors to this topic.

Disclosures

JKK, PR, MP, JCT, and WK declare that they have no competing interests.

Peer reviewers

Siam Oottamasathien, MD

Assistant Professor

Division of Pediatric Urology

University of Utah

Primary Children's Medical Center

Salt Lake City

UT

Disclosures

SO declares that she has no competing interests.

Jeffrey Donohoe, MD

Assistant Professor

Pediatric Urology

Medical College of Georgia

Augusta

GA

Disclosures

JD declares that he has no competing interests.

Daniel H. Williams, MD

Assistant Professor

Department of Urology

Head

Section of Male Infertility and Andrology

University of Wisconsin School of Medicine and Public Health

Madison

WI

Disclosures

DHW declares that he has no competing interests.

Edmund Sabanegh, Jr, MD

Director

Center for Male Fertility

Glickman Urological and Kidney Institute

Cleveland

OH

Disclosures

ES declares that he has no competing interests.

  • Differentials

    • Paratesticular mass
    • Cord hydrocele
    • Inguinal hernia
    More Differentials

  • Guidelines

    • Guidelines on paediatric urology
    • Sexual and reproductive health: male infertility
    More Guidelines

  • Patient information

    Varicocele

    Fertility problems: some reasons

    More Patient information
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