Varicocele: Difference between revisions

Revision as of 01:26, 25 June 2011

Background

Peak incidence: onset of puberty
Dilatation of spermatic cord veins (pampiniform plexus)
~90% occur on left
Can impair sperm production/function
Sudden appearance may be related to renal malignancy obstructing venous return

Diagnosis

Hx: Dullness/heaviness/scrotal discomfort
Physical exam
- "Bag of worms"
- More prominent w/ standing or Valsalva

DDx

Hydrocele
Hematocele
Spermatocele
Malignancy

Treatment

Scrotal support

Disposition

Referral to urologist
- Implications of possible subfertility should be discussed by urologist

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-#dilatation of pampiniform plexus and internal spermatic vein-occurs in 15-20% of all fertile males, 40% of infertile males
+*Peak incidence: onset of puberty
-#80-90% occur on L due to anatomy
+*Dilatation of spermatic cord veins (pampiniform plexus)
-#large (easily visualized), moderate (upon palpation), and small (palpable w valsalva)
+*~90% occur on left
-#can impair sperm production/function
+*Can impair sperm production/function
-#sudden appearance can be related to renal malignancy causing obstruction of venous return.
+*Sudden appearance may be related to renal malignancy obstructing venous return
-#nutcracker syndrome - when SMA compresses L renal vein causing varicocele.
 ==Diagnosis==
-#hx: worse w standing/valsalva. feeling of dullness/heaviness. scrotal discomfort.-doppler ultrasound. vein = 3mm or larger ==Work-Up==
+*Hx: Dullness/heaviness/scrotal discomfort
-#physical exam  ("bag of worms"). have the pt valsalva-may cause ipsilateral testicular atrophy-ultrasound ==DDx==
+*Physical exam
-#hydrocele, hematocele, spermatocele-malignancy. sertoli-leydig, testicular ca-abscess
+**"Bag of worms"
+**More prominent w/ standing or Valsalva
+==DDx==
+*Hydrocele
+*Hematocele
+*Spermatocele
+*Malignancy
 ==Treatment==
-#scrotal support
+*Scrotal support
-#Surgical tx if palpable and continued pain, infertility. varicocelectomy. ==Disposition==
-#if scrotal u/s confirm presence of only varicocele. followup as outpt w urology, non-urgent.
+==Disposition==
+*Referral to urologist
+**Implications of possible subfertility should be discussed by urologist
 ==Source==
-Adapted from(emed, mayo, utd)
+Tintinalli
 [[Category:GU]]
+[[Category:Peds]]