Varicocele

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 23 Jun 2024

Last updated: 23 Nov 2021

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.

Definition

A varicocele is the abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.[1]

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

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

Treatment algorithm

ACUTE

adolescent

adult

Contributors

Authors

Jay Ira Sandlow, MD

Professor and Vice-Chair

Department of Urology

Medical College of Wisconsin

Milwaukee

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

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

Disclosures

SO declares that she has no competing interests.

Jeffrey Donohoe, MD

Assistant Professor

Pediatric Urology

Medical College of Georgia

Augusta

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

Disclosures

DHW declares that he has no competing interests.

Edmund Sabanegh, Jr, MD

Director

Center for Male Fertility

Glickman Urological and Kidney Institute

Cleveland

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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Varicocele

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

adolescent

adult

Contributors

Authors

Jay Ira Sandlow, MD

Disclosures

Jagan K. Kansal, MD, MBA

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Siam Oottamasathien, MD

Disclosures

Jeffrey Donohoe, MD

Disclosures

Daniel H. Williams, MD

Disclosures

Edmund Sabanegh, Jr, MD

Disclosures

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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