eMedicine Specialties > Urology > Common Problems of the Testicle

Varicocele: Workup

Author: Wesley M White, MD, Chief Resident, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine, University of Tennessee Medical Center
Coauthor(s): Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center; Joe D Mobley III, MD, MPH, Chief Resident Physician, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine/University of Tennessee Medical Center
Contributor Information and Disclosures

Updated: Jul 28, 2009

Workup

Laboratory Studies

  • When the clinical examination findings are equivocal, high-resolution color-flow Doppler ultrasonography is the diagnostic method of choice. The Male Infertility Best Practice Policy Committee of the American Urological Society recommends that imaging studies are not indicated for the standard evaluation unless the physical examination provides inconclusive findings.2 If a patient has sudden onset of a varicocele, a single right-sided varicocele, or any varicocele that is not reducible in the supine position, consider possible retroperitoneal pathology (eg, renal cell carcinoma) as the cause of spermatic vein compression. Investigate further with appropriate ultrasonography or CT scanning before repairing the varicocele.
  • Although varicocele diagnosis may be assisted with numerous methods (eg, venography, radionuclide angiography, thermography, ultrasonography), the current standard of care is high-resolution color-flow Doppler ultrasonography. High-resolution real-time scrotal ultrasonography using a 7- to 10-MHz probe defines a varicocele as a hollow tubular structure that grows following a Valsalva maneuver.
  • Color-flow Doppler ultrasonography defines the anatomic and physiologic aspects of varicoceles by using real-time ultrasonography and pulsed Doppler in the same scan. The color of the signal identifies the blood flow and direction within the varicocele. The characteristic reverse flow of varicoceles is confirmed by prolonged flow augmentation within a colored flow area; the flow changes color (ie, reverses) on real-time imaging.
  • Although the exact size definition is controversial, most surgeons consider a varicocele to be a vein 3 mm in diameter or larger while the patient is at rest. McClure et al define a varicocele as the presence of 3 or more veins, with 1 having a minimum resting diameter of 3 mm or an increase in venous diameter with the Valsalva maneuver.6 Because other surgeons use 2-3 mm as a cutoff, comparing results of these ultrasound-based varicocelectomy studies is difficult.

More on Varicocele

Overview: Varicocele
Workup: Varicocele
Treatment: Varicocele
Follow-up: Varicocele
Multimedia: Varicocele
References
Further Reading
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References

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  2. [Best Evidence] Male Infertility Best Practice Policy Committee of the American Urological Assoc. Male Infertility Best Practice Policy Committee of the American Urological Association; Practice Committee of the American Society for Reproductive Medicine. Report on varicocele and infertility. Fertil Steril. Sep 2004;82 Suppl 1:S142-5. [Medline].

  3. Lipshultz LI, Corriere JN Jr. Progressive testicular atrophy in the varicocele patient. J Urol. Feb 1977;117(2):175-6. [Medline].

  4. Diamond DA, Zurakowski D, Atala A, Bauer SB, Borer JG, Cilento BG Jr, et al. Is adolescent varicocele a progressive disease process?. J Urol. Oct 2004;172(4 Pt 2):1746-8; discussion 1748. [Medline].

  5. Kass EJ, Belman AB. Reversal of testicular growth failure by varicocele ligation. J Urol. Mar 1987;137(3):475-6. [Medline].

  6. McClure RD, Khoo D, Jarvi K, Hricak H. Subclinical varicocele: the effectiveness of varicocelectomy. J Urol. Apr 1991;145(4):789-91. [Medline].

  7. Madgar I, Weissenberg R, Lunenfeld B, Karasik A, Goldwasser B. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril. Jan 1995;63(1):120-4. [Medline].

  8. Vazquez-Levin MH, Friedmann P, Goldberg SI, Medley NE, Nagler HM. Response of routine semen analysis and critical assessment of sperm morphology by Kruger classification to therapeutic varicocelectomy. J Urol. Nov 1997;158(5):1804-7. [Medline].

  9. Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet. May 31 2003;361(9372):1849-52. [Medline].

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  13. Chan PT, Wright EJ, Goldstein M. Incidence and postoperative outcomes of accidental ligation of the testicular artery during microsurgical varicocelectomy. J Urol. Feb 2005;173(2):482-4. [Medline].

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  20. Lima SS, Castro MP, Costa OF. A new method for the treatment of varicocele. Andrologia. Mar-Apr 1978;10(2):103-6. [Medline].

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  23. Matthews GJ, Matthews ED, Goldstein M. Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil Steril. Jul 1998;70(1):71-5. [Medline].

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  27. Sawczuk IH, Hensle TW, Burbige KA, Nagler HM. Varicoceles: Effect on testicular volume in prepubertal and pubertal males. Urology. 1993;41:466-468. [Medline].

  28. Steckel J, Dicker AP, Goldstein M. Relationship between varicocele size and response to varicocelectomy. J Urol. Apr 1993;149(4):769-71. [Medline].

  29. Walsh PC, White RI Jr. Balloon occlusion of the internal spermatic vein for the treatment of varicoceles. JAMA. Oct 9 1981;246(15):1701-2. [Medline].

  30. Wang C, McDonald V, Leung A, Superlano L, Berman N, Hull L, et al. Effect of increased scrotal temperature on sperm production in normal men. Fertil Steril. Aug 1997;68(2):334-9. [Medline].

  31. Weissbach L, Thelen M, Adolphs HD. Treatment of idiopathic varicoceles by transfemoral testicular vein occlusion. J Urol. Sep 1981;126(3):354-6. [Medline].

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Keywords

varicocele, varicoceles, scrotal varicocele, varicocelectomy, pampinocele, pampiniform venous plexus, spermatic vein, arrest of sperm secretion, male fertility, male infertility, low sperm count, poor sperm function, dilation of the pampiniform venous plexus, testicular vein, antireflux valve, spermatogonia, Valsalva maneuver, sperm production, sperm function, testicular pain, scrotal pain, testicular swelling, scrotal swelling, spermatogenesis, infertility, fertility treatment, male factor infertility, infertility treatment, testicular thermoregulation, stress pattern of semen, poor sperm production, decreased semen quality

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Contributor Information and Disclosures

Author

Wesley M White, MD, Chief Resident, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine, University of Tennessee Medical Center
Wesley M White, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, Endourological Society, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

Joe D Mobley III, MD, MPH, Chief Resident Physician, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine/University of Tennessee Medical Center
Joe D Mobley III, MD, MPH is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Endourological Society, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Gamal Mostafa Ghoniem, MD, FACS, Fellowship Program Director, Clinical Professor of Surgery, Head, Section of Voiding Dysfunction, Female Urology and Reconstruction, Cleveland Clinic Florida
Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urogynecologic Society, American Urological Association, Florida Medical Association, International Continence Society, and International Urogynaecology Association
Disclosure: Astellas Honoraria Speaking and teaching; Coloplasty Consulting fee Consulting; Uroplasty Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Jeffrey Noble, MD, Consulting Staff, Urologic Institute, Cleveland Clinic Foundation
Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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