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Varicocele Workup

  • Author: Wesley M White, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
Updated: Dec 03, 2015

Laboratory Studies

See the list below:

  • 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.[5] 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.[13] Because other surgeons use 2-3 mm as a cutoff, comparing results of these ultrasound-based varicocelectomy studies is difficult.

Imaging Studies

Ultrasonography, particularly Doppler ultrasonography, allows accurate diagnosis of varicoceles. Computed tomography can demonstrate varicoceles, but exposure to radiation is a disadvantage, and the diagnostic role of magnetic resonance imaging has not been established. Venography is usually reserved for use in patients undergoing occlusive therapy, for mapping of the venous anatomy. For complete discussion of this topic, see Varicocele Imaging.

Contributor Information and Disclosures

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, Tennessee Medical Association

Disclosure: Nothing to disclose.


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, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Joe D Mobley, III, MD, MPH Urologist, Kentucky Lake Urology Clinic

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, Tennessee Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, SWOG

Disclosure: Nothing to disclose.

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, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Gamal Mostafa Ghoniem, MD, FACS Professor and Vice Chair of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American Urogynecologic Society, International Continence Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, American College of Surgeons, American Urological Association

Disclosure: Received honoraria from Astellas for speaking and teaching; Received grant/research funds from Uroplasty for none; Partner received honoraria from Allergan for speaking and teaching.

  1. Gat Y, Bachar GN, Zukerman Z, Belenky A, Gornish M. Varicocele: a bilateral disease. Fertil Steril. 2004 Feb. 81(2):424-9. [Medline].

  2. Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion?. Urology. 1993 Nov. 42(5):541-3. [Medline].

  3. Bogaert G, Orye C, De Win G. Pubertal screening and treatment for varicocele do not improve chance of paternity as adult. J Urol. 2013 Jun. 189(6):2298-303. [Medline].

  4. Chen SS, Chen LK. Risk factors for progressive deterioration of semen quality in patients with varicocele. Urology. 2012 Jan. 79(1):128-32. [Medline].

  5. 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. 2004 Sep. 82 Suppl 1:S142-5. [Medline].

  6. [Guideline] Jungwirth A, Diemer T, Dohle GR, Giwercman A, Kopa Z, Krausz C, et al. Guidelines on Male Infertility. European Association of Urology. Available at March 2014; Accessed: December 1, 2015.

  7. Condorelli RA, Calogero AE, Mongioi' L, Vicari E, Russo GI, Lanzafame F, et al. Varicocele and concomitant dilation of the periprostatic venous plexus: effects on semen viscosity sperm parameters. J Endocrinol Invest. 2015 Oct 30. [Medline].

  8. Diamond DA. Adolescent varicocele. Curr Opin Urol. 2007 Jul. 17(4):263-7. [Medline].

  9. Casey JT, Misseri R. Adolescent Varicoceles and Infertility. Endocrinol Metab Clin North Am. 2015 Dec. 44 (4):835-42. [Medline].

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

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

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

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

  14. Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM. Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective From a Randomized, Controlled Trial. Eur Urol. 2010 Dec 21. [Medline].

  15. Rizkala E, Fishman A, Gitlin J, Zelkovic P, Franco I. Long term outcomes of lymphatic sparing laparoscopic varicocelectomy. J Pediatr Urol. 2013 Aug. 9(4):458-63. [Medline].

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

  17. 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. 1997 Nov. 158(5):1804-7. [Medline].

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

  19. Grober ED, Chan PT, Zini A, Goldstein M. Microsurgical treatment of persistent or recurrent varicocele. Fertil Steril. 2004 Sep. 82(3):718-22. [Medline].

  20. Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost effective analysis. Urology. 1997. 49:83-90. [Medline].

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

  22. Hopps CV, Goldstein M. Varicocele: Unified Theory of Pathophysiology and Treatment. AUA Update Series. 2004. 23:90-95.

  23. Hopps CV, Lemer ML, Schlegel PN, Goldstein M. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol. 2003 Dec. 170(6 Pt 1):2366-70. [Medline].

  24. Kadioglu A, Tefekli A, Cayan S, Kandirali E, Erdemir F, Tellaloglu S. Microsurgical inguinal varicocele repair in azoospermic men. Urology. 2001 Feb. 57(2):328-33. [Medline].

  25. Shabana W, Teleb M, Dawod T, Elsayed E, Desoky E, Shahin A, et al. Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study. Can Urol Assoc J. 2015 Sep-Oct. 9 (9-10):E579-82. [Medline]. [Full Text].

A large varicocele is seen through the scrotal skin. In a patient with a varicocele, the dilated vessels of the pampiniform plexus are easily appreciated within the scrotum.
Incision for an inguinal approach to varicocele repair.
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