Varicocele: Difference between revisions
| Line 17: | Line 17: | ||
==Evaluation== | ==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== | ==Management== | ||
Revision as of 06:32, 27 November 2019
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)
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