Varicocele
Revision as of 13:31, 14 March 2011 by Rossdonaldson1 (talk | contribs)
Background
- dilatation of pampiniform plexus and internal spermatic vein-occurs in 15-20% of all fertile males, 40% of infertile males
- 80-90% occur on L due to anatomy
- large (easily visualized), moderate (upon palpation), and small (palpable w valsalva)
- can impair sperm production/function
- sudden appearance can be related to renal malignancy causing obstruction of 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==
- physical exam ("bag of worms"). have the pt valsalva-may cause ipsilateral testicular atrophy-ultrasound ==DDx==
- hydrocele, hematocele, spermatocele-malignancy. sertoli-leydig, testicular ca-abscess
Treatment
- 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.
Source
Adapted from(emed, mayo, utd)