Varicocele

Question 1

What is a varicocele?

Answer 1

Dilated veins of the pampiniform plexus

Question 2

Effects of varicocele?

Answer 2

pain

testis damage

testis atrophy

Infertility –> stress pattern on semen analysis

Question 3

What does varicocele feel like on PE?

Answer 3

bag of warms

can be grade I, II, III

Question 4

Grade I varicocele?

Answer 4

Small size, not grossly visible, only palpable during Valsalva

Question 5

Grade II varicocele?

Answer 5

Moderate in size, not grossly visible, palpable while standing

Question 6

Grade III varicocele?

Answer 6

Large size, grossly visible

Question 7

Varicocele are usually on the…

Answer 7

left

BUT if on right side and of rapid onset, can signal renal malignancy –> consider imaging

Question 8

How should you manage varicocele?

Answer 8

surveillance

surg: varicocele repair , varicocelectomy

Question 9

When might you do surveillance rather than invasive tx for varicocele?

Answer 9

if palpable varicocele with normal semen analysis in young (repeat semen analysis every 1-2 yrs)

varicocele with normal testis size in children –> measure testicular size

Question 10

Indications for surg?

Answer 10

sxs

palpable varicocele with abn. semen analysis in eval of infertile couple

varicocele with small testis –> can revere

Question 11

What are the types of surg for varicocele?

Answer 11

Ligation of vein to redirect venous outflow

• Open surgery
• Laparoscopic surgery

Percutaneous embolization

Question 12

3-6 months after varicocele repair…

Answer 12

improvement in semen quality is seen in 70% of men