Summary
Definition
History and exam
Key diagnostic factors
- painless scrotal mass
- left-sided signs/symptoms
- small testicle
Other diagnostic factors
- subfertility/infertility
- age >12
- scrotal or groin pain
Risk factors
- somatometric parameters (tall/low BMI)
- family history of varicocele
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- scrotal ultrasound with color flow Doppler imaging
- semen analysis
- serum follicle-stimulating hormone (FSH) (± GnRH stimulation)
- serum testosterone
- DNA fragmentation index (DFI)
- CT abdomen/pelvis
- MRI abdomen/pelvis
- retroperitoneal ultrasound
Treatment algorithm
adolescent
adult
Contributors
Autores
Jay Ira Sandlow, MD
Professor and Chair
Department of Urology
Medical College of Wisconsin
Milwaukee
WI
Divulgaciones
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
Assistant Professor
Massachusetts General Hospital
Boston
MA
Divulgaciones
DLP declares that he has no competing interests.
Agradecimientos
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.
Divulgaciones
JKK, PR, MP, JCT, and WK declare that they have no competing interests.
Revisores por pares
Siam Oottamasathien, MD
Assistant Professor
Division of Pediatric Urology
University of Utah
Primary Children's Medical Center
Salt Lake City
UT
Divulgaciones
SO declares that she has no competing interests.
Jeffrey Donohoe, MD
Assistant Professor
Pediatric Urology
Medical College of Georgia
Augusta
GA
Divulgaciones
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
Divulgaciones
DHW declares that he has no competing interests.
Edmund Sabanegh, Jr, MD
Director
Center for Male Fertility
Glickman Urological and Kidney Institute
Cleveland
OH
Divulgaciones
ES declares that he has no competing interests.
Agradecimiento de los revisores por pares
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Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Brannigan RE, Hermanson L, Kaczmarek J, et al. Updates to male infertility: AUA/ASRM guideline (2024). J Urol. 2024 Dec;212(6):789-99. Resumen
European Association of Urology. Sexual and reproductive health guidelines. Apr 2025 [internet publication].Texto completo
Persad E, O'Loughlin CA, Kaur S, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev. 2021 Apr 23;4:CD000479.Texto completo Resumen
European Association of Urology. Guidelines on paediatric urology. Apr 2024 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Paratesticular mass
- Cord hydrocele
- Inguinal hernia
Más DiferencialesGuías de práctica clínica
- Sexual and reproductive health: male infertility
- Guidelines on paediatric urology
Más Guías de práctica clínicaFolletos para el paciente
Varicocele
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