Varicocele

Last reviewed: 6 Jun 2022
Last updated: 23 Nov 2021

Summary

Definition

History and exam

Key diagnostic factors

  • painless scrotal mass
  • left-sided signs/symptoms
  • small testicle
More key diagnostic factors

Other diagnostic factors

  • infertility
  • age >12
  • scrotal or groin pain
Other diagnostic factors

Risk factors

  • somatometric parameters (tall/low BMI)
  • family history of varicocele
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations 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
More investigations to consider

Treatment algorithm

ACUTE

adolescent

adult

Contributors

Authors

Jay Ira Sandlow, MD

Professor and Vice-Chair

Department of Urology

Medical College of Wisconsin

Milwaukee

WI

Disclosures

JIS declares that he has no competing interests.

Jagan K. Kansal, MD, MBA

Fellow in Male Reproductive and Sexual Health

Department of Urology

Medical College of Wisconsin

Milwaukee

WI

Disclosures

JKK declares that he has no competing interests.

Acknowledgements

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

Disclosures

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.

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