A varicocele is an abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.
Incidence is 15% in adolescent boys and adult men; 90% occur on the left side; 10% are bilateral.
May impede adolescent testicular growth and affect adult sperm parameters and testosterone production.
40% of men being evaluated in a male fertility clinic will have a varicocele.
Diagnosis is usually clinical; ultrasound may be helpful where there is doubt about the diagnosis.
Surgical correction may reverse testicular growth arrest in adolescents and improve semen parameters in adults.
A varicocele is the abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.
History and exam
Key diagnostic factors
- presence of risk factors
- painless scrotal mass
- left-sided signs/symptoms
- small testicle
Other diagnostic factors
- age over 12 years
- scrotal or groin pain
- somatometric parameters (tall/low BMI)
- family history of varicocele
1st investigations to order
- clinical diagnosis
Investigations to consider
- scrotal ultrasound with colour flow Doppler imaging
- semen analysis
- serum FSH (± GnRH stimulation)
- serum testosterone
- DNA fragmentation index (DFI)
- CT abdomen/pelvis
- MRI abdomen/pelvis
- retroperitoneal ultrasound
- Paratesticular mass
- Cord hydrocele
- Inguinal hernia
- Guidelines on paediatric urology
- Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II
Fertility problems: some reasons
Fertility problems: what treatments work?More Patient leaflets
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