Varicocele

Background

Cross section showing the pampiniform venus plexus.
Varicocele.png
  • 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

Varicocele on left
  • Scrotal mass and discomfort (dullness/heaviness)
  • Physical exam
    • "Bag of worms"
    • More prominent with standing or Valsalva
    • Does not trans-illuminate

Differential Diagnosis

Testicular Diagnoses

Evaluation

Testicular ultrasound showing left varicocele.

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

See Also

References

  1. Pryor JL, Howards SS. Varicocele. Urol Clin North Am. 1987 Aug;14(3):499-513.
  2. Kantartzi PD, Goulis CD, Goulis GD, Papadimas I. Male infertility and varicocele: myths and reality. Hippokratia. 2007;11(3):99-104.