Varicocele: Difference between revisions
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==Background== | ==Background== | ||
[[File:Figure 28 01 02.jpg|thumb|Scrotal anatomy]] | |||
[[File:Gray1147.png|thumb|Cross section showing the pampiniform venus plexus.]] | |||
[[File:Varicocele.png|thumb|]] | |||
*Peak incidence: onset of puberty | *Peak incidence: onset of puberty | ||
*Dilatation of spermatic cord veins (pampiniform plexus) | *Dilatation of spermatic cord veins (pampiniform plexus) | ||
**~90% occur on left due to 90 degree turn of | **~90% occur on left due to 90 degree turn of left testicular vein into left renal vein<ref>Pryor JL, Howards SS. Varicocele. Urol Clin North Am. 1987 Aug;14(3):499-513.</ref> | ||
**R testicular vein drains into IVC | **R testicular vein drains into IVC | ||
***If right-sided, consider inferior vena cava thrombosis | ***If right-sided, consider inferior vena cava thrombosis | ||
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==Clinical Features== | ==Clinical Features== | ||
[[File:Varikozele2.jpg|thumb|Varicocele on left]] | |||
*Scrotal mass and discomfort (dullness/heaviness) | *Scrotal mass and discomfort (dullness/heaviness) | ||
*Physical exam | |||
**"Bag of worms" | |||
**More prominent with standing or Valsalva | |||
**Does not trans-illuminate | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Testicular DDX}} | {{Testicular DDX}} | ||
== | ==Evaluation== | ||
* | [[File:Trans varicocele.jpg|thumb|Testicular ultrasound showing left varicocele.]] | ||
* | ===Workup=== | ||
*Consider UA | |||
* | *Consider testicular ultrasound | ||
===Diagnosis=== | |||
*May be clinical vs. based on ultrasound | |||
== | ==Management== | ||
*Scrotal support (for symptomatic relief) | *Scrotal support (for symptomatic relief) | ||
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<references/> | <references/> | ||
[[Category: | [[Category:Urology]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
Latest revision as of 20:22, 4 June 2020
Background
- Peak incidence: onset of puberty
- Dilatation of spermatic cord veins (pampiniform plexus)
- ~90% occur on left due to 90 degree turn of left testicular vein into left renal vein[1]
- R testicular vein drains into IVC
- If right-sided, consider inferior vena cava thrombosis
- Can impair sperm production/function leading to infertility[2]
- Sudden appearance may be related to renal malignancy obstructing venous return
Clinical Features
- Scrotal mass and discomfort (dullness/heaviness)
- Physical exam
- "Bag of worms"
- More prominent with standing or Valsalva
- Does not trans-illuminate
Differential Diagnosis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Evaluation
Workup
- Consider UA
- Consider testicular ultrasound
Diagnosis
- May be clinical vs. based on ultrasound
Management
- Scrotal support (for symptomatic relief)
Disposition
- Discharge with urology referral
- Implications of possible subfertility should be discussed with patient by urologist