Varicocele: Difference between revisions
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*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 | **~90% occur on left due to 90 degree turn of L testicular vein into L renal vein<ref>Pryor JL, Howards SS. Varicocele. Urol Clin North Am. 1987 Aug;14(3):499-513.</ref> | ||
**If right sided, consider inferior vena cava thrombosis | **R testicular vein drains into IVC | ||
***If right-sided, consider inferior vena cava thrombosis | |||
*Can impair sperm production/function<ref>Kantartzi PD, Goulis CD, Goulis GD, Papadimas I. Male infertility and varicocele: myths and reality. Hippokratia. 2007;11(3):99-104.</ref> | *Can impair sperm production/function<ref>Kantartzi PD, Goulis CD, Goulis GD, Papadimas I. Male infertility and varicocele: myths and reality. Hippokratia. 2007;11(3):99-104.</ref> | ||
*Sudden appearance may be related to renal malignancy obstructing venous return | *Sudden appearance may be related to renal malignancy obstructing venous return | ||
Revision as of 19:59, 17 February 2016
Background
- Peak incidence: onset of puberty
- Dilatation of spermatic cord veins (pampiniform plexus)
- ~90% occur on left due to 90 degree turn of L testicular vein into L renal vein[1]
- R testicular vein drains into IVC
- If right-sided, consider inferior vena cava thrombosis
- Can impair sperm production/function[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
Diagnosis
- Physical exam
- "Bag of worms"
- More prominent w/ standing or Valsalva
- Does not trans-illuminate
Treatment
- Scrotal support (for symptomatic relief)
Disposition
- Discharge with urology referral
- Implications of possible subfertility should be discussed with patient by urologist