Varicocele

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

Testicular Diagnoses

• Scrotal cellulitis
• Epididymitis
• Fournier gangrene
• Hematocele
• Hydrocele
  • Hydrocele (peds)
• 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

Treatment

• Scrotal support

Disposition

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

Source

Tintinalli