Varicocele

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.

-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.

Adapted from ....(emed, mayo, utd)

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