Materiały źródłowe

• #1

  https://www.aurorahealthcare.org/services/urology/varicoceles

  A varicocele is a condition where veins within the pouch of skin that holds the testicles (the scrotum) become swollen. It occurs when the valves within the veins that regulate blood flow in the spermatic cord don’t function correctly, causing blood to pool and the veins to swell. This leads to the formation of a varicose vein, similar to varicose veins that can occur in the legs. […] The varicocele diagnosis process involves a combination of a physical exam, medical history review and a review of your symptoms. During the physical exam, your doctor may perform an exam of your scrotum. […] Your provider may also order other tests to accurately diagnose varicoceles, including: Digital imaging: An ultrasound provides a visual of the veins in the testicles and is the most common test used to diagnose varicoceles. Blood tests: A blood test is used to check hormone levels, including testosterone and follicle-stimulating hormones (FSH), which affects sexual development in children. Semen analysis: A semen analysis is often ordered to check the health of the sperm and to see if a varicocele is affecting fertility.

• #1 Varicocele – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/varicocele/diagnosis-treatment/drc-20378772

  Your health care provider can diagnose a varicocele by visual inspection of the scrotum and by touch. You’ll likely be examined while lying down and standing up. […] When you’re standing, your health care provider may ask you to take a deep breath, hold it and bear down, similar to the pressure during a bowel movement. This technique (Valsalva maneuver) can make a varicocele easier to examine. […] Your health care provider may want you to have an ultrasound exam. Ultrasound uses high-frequency sound waves to create images of structures inside your body. These images may be used to: […] Confirm the diagnosis or characterize the varicocele […] Eliminate another condition as a possible cause of signs or symptoms […] Detect a lesion or other factor obstructing blood flow. […] A varicocele that doesn’t cause pain or discomfort which is common may be diagnosed during a routine wellness exam. It may also be diagnosed during a more complex diagnostic process for fertility treatment.

• #1

  https://link.springer.com/article/10.1007/s40746-024-00316-2

  Pediatric varicoceles are common, yet the paucity of data on long-term fertility outcomes does not establish recommendations for conservative management and reassurance versus pediatric urology referral for consideration of surgical intervention. […] The initial evaluation of pediatric varicoceles includes focused history, physical exam, and use of an orchidometer or ultrasound for volume assessment. […] Most clinical practice guidelines agree that the diagnosis of a varicocele in this population is primarily based on physical examination. […] According to the American Urological Association (AUA) and the American Society of Reproductive Medicine (ASRM), if the physical examination is inconclusive, a scrotal ultrasound may be performed. […] Varicoceles are graded using the Dubin and Amelar system: Grade 0, subclinical varicocele (not detectable on clinical examination but identified on scrotal ultrasound [US] or venography); Grade I, small varicocele (palpated only during the Valsalva maneuver); Grade II, moderate size (readily palpable without the Valsalva maneuver but not readily visible without Valsalva); and Grade III, large size (readily visualized without Valsalva).

• #1

  https://journals.lww.com/ajandrology/fulltext/2016/18020/diagnosis_of_clinical_and_subclinical_varicocele_.6.aspx

  Despite these limitations, physical examination still represents the gold standard for diagnosing clinically significant varicoceles, which have the clearest indications for repair. […] Scrotal ultrasound is currently the most established and widely used modality for the study of varicoceles. […] Given its high sensitivity and specificity (97% and 94% when compared to venography), noninvasive nature, and relative ease of performance, scrotal ultrasound with Doppler examination has become the study of choice in evaluating scrotal and testicular pathology. […] The most recent AUA and ASRM guidelines do not recommend the routine use of scrotal ultrasound to diagnose varicoceles. Instead, the role of scrotal ultrasound is reserved for situations in which physical examination is inconclusive, such as patients with large body habitus or thick scrotal skin precluding accurate examination. […] The widespread use of scrotal ultrasound, however, has resulted in increased detection of subclinical varicoceles.

• #1 Varicocele Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/382288-overview

  The existence of veins larger than 2 mm is a commonly used ultrasound criterion for diagnosing varicocele, with a sensitivity of 95%. […] Functional MRI techniques, such as diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI, and MR spectroscopy have been shown to provide important diagnostic information for diagnosing testicular diseases. […] Venography is the most reliable modality for the detection of subclinical varicoceles, because the findings demonstrate abnormal retrograde flow into the spermatic veins or pampiniform plexus. […] Although the diagnosis and management of varicoceles have not been standardized, there are many published guidelines available, such as those by the American Society of Reproductive Medicine, American Urological Association, European Association of Urology, and World Health Organization.

• #1 Varicocele | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/varicocele-1?lang=us

  Varicocele is the dilatation of the pampiniform plexus of veins, a network of many small veins found in the male spermatic cord. It is the most frequently encountered mass of the spermatic cord. […] The estimated incidence is at ~15% of the general male population and ~40% of subfertile and infertile men (the most common cause of correctable male infertility). […] Varicocele can be asymptomatic. If symptomatic, presentations include: scrotal mass/swelling, scrotal pain, testicular atrophy, infertility or subfertility. […] The diagnostic modality of choice: dilatation of pampiniform plexus veins 2-3 mm in diameter, characteristically have a serpentine appearance, there can be flow reversal with the Valsalva maneuver, Doppler ultrasound can be used to grade the degree of reflux. […] This is one of the surgically correctable causes of male infertility. Management options include: embolization of the testicular vein, surgical ligation of the testicular vein.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5269523/

  A varicocele is described as pathologically enlarged, tortuous veins of the pampiniform plexus, leading to an increased testicular temperature and adrenal metabolite reflux into the testes. […] The diagnosis of varicocele is based on medical history and physical examination, which involves palpation and observation of the scrotum at rest and during the Valsalva maneuver. Ultrasound is the imaging method of choice. […] However, diagnostic ultrasound is still a controversial method due to numerous and often divergent classification systems for varicocele assessment as well as its poor correlation with clinical manifestations. […] The diagnosis of varicocele is based on medical history and physical examination. Most patients with varicocele are asymptomatic. […] Physical examination involves palpation and observation of the scrotum at rest and during the Valsalva maneuver.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5269523/

  The use of ultrasonography is not generally recommended. It is recommended only by the European Association of Urology in patients with visible or palpable dilated veins in the pampiniform plexus. […] According to the American Society for Reproductive Medicine, ultrasonography should not be used as a basic examination in all patients with varicocele, but its place in the diagnostic algorithm should be defined as complementary. […] Currently, ultrasound is the most commonly performed imaging technique in patients with varicocele. […] Ultrasound examination of varicocele is performed in a patient in a supine position. […] The measurement of the diameter of the veins in the pampiniform plexus and the assessment of potential reflux are performed in a supine position. […] Despite the popularity of ultrasound imaging, there is no universal and recognized system to classify varicocele severity.

• #1 Varicocele Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/438591-workup

  When the clinical examination findings are equivocal, high-resolution color-flow Doppler ultrasonography is the diagnostic method of choice. […] 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. […] Color-flow Doppler ultrasonography defines the anatomic and physiologic aspects of varicoceles by using real-time ultrasonography and pulsed Doppler in the same scan. […] Tsili et al describe the use of 1.5 T diffusion tensor imaging (DTI) MRI as an adjunct tool for the diagnosis of varicocele. […] Other pilot studies of diffusion-weighted imaging MRI have reported that decreased apparent diffusion coefficient (ADC) values in the testicles of patients with varicocele correlate with abnormal semen parameters.

• #1

  https://link.springer.com/article/10.1007/s40746-024-00316-2

  The European Society of Paediatric Urology (ESPU) recommends evaluating the size of both testicles by orchidometer or ultrasound, and a testis that is smaller by 2 ml or 20% compared to the other testis is considered hypoplastic. […] The European Association of Urology (EAU) recommends confirmation of varicocele by color duplex Doppler analysis after physical examination. […] Semen analysis (SA) may be the most accurate predictor of future fertility, but its role in the evaluation of varicoceles in adolescents is unclear. […] In Tanner V patients with any of the aforementioned parameters, SA should be offered as an accurate and confirmatory assessment of current testicular and sperm function. […] Surgical intervention should be considered in adolescents with pain, undesirable cosmetic appearance, bilateral varicoceles, significantly altered persistent TAI (20%) or TVD (11%), persistent low TTV (29.5 cc), PRF38 cm/s, the 20/38 harbinger, abnormal TMSC on serial SA, or infertility.

• #1 Varicocele: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/varicocele

  How is a varicocele diagnosed? […] There are several ways that your doctor may diagnose a varicocele, including: […] Physical exam. Because a varicocele cant always be felt or seen when youre lying down, your doctor will most likely examine your testicles while youre standing up and lying down. […] Valsalva maneuver. This technique is often used to diagnose smaller varicoceles. The Valsalva maneuver typically requires you to stand, take a deep breath, hold it, and bear down while the doctor examines your scrotum. […] Scrotal ultrasound. In some cases, a scrotal ultrasound may be necessary. This helps measure the spermatic veins and allows your doctor to get a detailed, accurate picture of the condition. […] Once the varicocele is diagnosed, your doctor will classify it with one of three clinical grades. Theyre labeled grades 1 through 3, according to the size of the lump in your testicle. Grade 1 is the smallest, and grade 3 is the largest.

• #1 Varicocele: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15239-varicocele

  Varicoceles are swollen veins in your scrotum. A healthcare provider can diagnose a varicocele and recommend the proper treatment. […] Varicoceles can affect fertility. Varicoceles can contribute to about 40% of all cases of male infertility. […] Talk to a healthcare provider if you suspect you have infertility. Fertility concerns are the top reason why people receive varicocele treatment. […] A healthcare provider can diagnose a varicocele. Theyll review your medical history, ask questions about your symptoms and perform a physical examination. […] They may also order the following tests to confirm their diagnosis: Pelvic ultrasound, Semen analysis, Blood test. […] After confirming the presence of a varicocele, your provider will grade its severity. […] If you have concerns about your ability to have a biological child, talk to a healthcare provider. Theyll help you understand your options. […] Talk to a healthcare provider if you have varicocele symptoms, including an inability to get your partner pregnant. They can diagnose a varicocele and recommend the best treatment for you.

• #1 Varicoceles Diagnosis | Center for Male Reproductive Medicine & Microsurgery

  https://maleinfertility.org/procedures/microsurgical-varicocelectomy/diagnosis

  A recent meta-analysis by Marmar et al. clearly shows a significant increase in pregnancy rates after microsurgical varicocelectomy. […] A multi-center WHO study on the influence of varicocele on fertility parameters demonstrated that the mean testosterone (T) concentration of men older than 30 years of age with varicoceles was significantly lower than that of younger patients with varicoceles, whereas this trend was not seen in men without varicoceles. […] Repairing varicoceles appears to improve serum testosterone (T) levels. […] The abnormalities of semen parameters in infertile men with varicocele were first objectively described by Macleod in 1965. […] A large number of studies have evaluated the effects of varicocelectomy on semen parameters. Most of these studies have demonstrated an improvement in sperm density with or without a concomitant increase in sperm motility and morphology after varicocelectomy, suggesting a cause and effect relationship between varicocele and abnormal semen parameters. […] The impact of the grade of varicocele on the magnitude of improvement in semen quality after varicocelectomy is not surprising.

• #1 Varicocele: Causes, Symptoms, and Diagnosis

  https://www.urology-textbook.com/varicocele.html

  A varicocele is defined as ectatic and tortuous veins of the pampiniform plexus of the spermatic cord. […] Varicocele is common; approximately 411% of adult males have a varicocele by clinical examination. […] The prevalence is up to 30% when Doppler sonography is used for varicocele diagnosis. […] Signs of varicocele are ectatic veins in the spermatic cord (venous diameter of more than 3.5 mm) and a reduced testicular size (difference 20% or 2 ml). […] It is essential to exclude testicular or retroperitoneal tumors. […] Pathological findings in semen analysis (oligozoospermia, asthenozoospermia, teratozoospermia) and DNA fragmentation of spermatozoa are possible. […] The grading of varicocele correlates with markers of subfertility: for example, up to 55% of men with grade III varicocele have a pathological semen analysis. […] An elevated FSH and low testosterone are typical for a testicular dysfunction due to a high-grade varicocele.

• #1 Varicocele | Department of Urologic Surgery | UC Davis Health

  https://health.ucdavis.edu/urology/specialties/male_infertility_and_sexual_dysfunction/Varicocele/varicocele.html

  A varicocele is defined as dilation of the veins that drain the testicle. It is typically diagnosed during a physical exam of the scrotum and graded according to the following scale: grade I varicocele (felt only during Valsalva maneuver), grade II (felt in the standing position without valsalva), and grade III (visible). […] Typically, a varicocele is felt on an examination in a patient being evaluated for pain or infertility. With an infertility diagnosis, and occasionally in patients with pain only, Dr. Clavijo will generally recommend a semen analysis to assess the patients fertility potential. A semen analysis will usually report on a mans sperm count, sperm movement, semen volume and other factors that are thought to be important to measure a mans fertility potential. […] Based on the interpretation of many studies done on varicocele repair, patients can expect to have an improvement in their sperm count and movement, although there are exceptions with some patients improving more than others and the very rare patient having a slight decline in semen quality.

• #1 Varicocele: Diagnosis and Treatment

  https://www.drelist.com/blog/varicocele-diagnosis-and-treatment

  A physician usually diagnoses varicocele after a physical examination during which you will be examined standing up and lying down. Varicocele may be easier to feel or see when you are standing up, since the veins are more likely to fill and expand when you are standing. […] If you have a lump on your testicles, a scrotal ultrasound will be used to measure the size of the spermatic veins. This will allow accurate classification of the varicocele into a clinical category. Ultrasound allows measurement of the diameter of the spermatic cord and the veins that serve the testicles. The most accurate type of scrotal ultrasound study is a color Doppler study, which is indicated if the diagnosis is uncertain after physical examination. […] Other methods are rarely necessary to determine the diagnosis, but they include venography and CT scans, which are useful to identify any tumors that are obstructing the testicular veins. Blood tests may be useful to determine if there has been an injury to the testicle. These tests include measurement of levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH.) However, these test are rarely of interest unless fertility is a concern.

• #1 Varicocele Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/382288-overview

  Technetium-99m (99mTc) labeled red blood cells are the radiopharmaceutical agent of choice for the evaluation of varicoceles, although other radionuclides have been used as well. […] Venography is the most reliable modality for the detection of small or subclinical varicoceles, because findings demonstrate abnormal venous blood reflux in a retrograde fashion into the internal spermatic vein (ISVs) and the pampiniform plexus.

• #1 Varicocele Embolization for Infertility – Endovascular Today

  https://evtoday.com/articles/2017-apr/varicocele-embolization-for-infertility

  First, scrotal ultrasound should be performed on all patients, even in the case of a clinically obvious varicocele. […] Surgical ligation and percutaneous embolization achieve similar clinical outcomes. […] Varicocele embolization is safe and technically effective and achieves comparable results to surgery while offering the advantages of shorter recovery time, avoidance of general anesthetic, and patient preference.

• #1 Varicocele Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/382288-overview

  CT scanning with increased intra-abdominal pressure can be used as a noninvasive method to detect a varicocele and to show proximal extension of the lesion into the inguinal canal. […] On MRIs, a varicocele is demonstrated as a mass of dilated serpiginous vessels, usually adjacent to the epididymal head. […] Ultrasonographic findings of varicoceles include tortuous anechoic tubular structures adjacent to the testis. […] Ultrasonography has been reported to have a 97% sensitivity and 94% specificity for the diagnosis of clinical varicocele. […] Color Doppler ultrasonographic imaging can be helpful in differentiating venous channels from epidermoid cysts or spermatoceles when doubt exists. […] Tissue elastography ultrasound measures the stiffness of tissue. According to Dede et al, acoustic radiation force impulse (ARFI) elastography can measure early damage of testicular structure by varicoceles.

• #1 Varicocele – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/varicocele/symptoms-causes/syc-20378771

  A varicocele may cause poor development of a testicle, low sperm production or other problems that may lead to infertility. […] A number of conditions could contribute to pain, swelling or a mass in the scrotum. If you experience any of these, see your health care provider to get a timely and accurate diagnosis. […] The exact cause of a varicocele is unknown. One contributing factor may be the malfunction of valves inside the veins that are intended to keep blood moving in the right direction. […] A varicocele doesn’t necessarily cause infertility. An estimated 10% to 20% of men diagnosed with a varicocele experience difficulty fathering a child. Among men with fertility problems, about 40% have a varicocele.

• #1 Varicocele: strategies in diagnosis and treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10087130/

  Varicocele can be very easily diagnosed by physical examination and subsequently treated when it is painful or associated with testicular hypotrophy. […] However, palpability of the spermatic vein and reflux in low grade or even questionable varicoceles can be difficult to assess without imaging modalities. […] However, a gold standard that defines the presence of a subclinical varicocele has not yet been established. […] The different diagnostic tools based on ultrasonography investigated these past years to define a flow reversal in incontinent spermatic veins are presented in the first part of this review, with emphasis on subclinical varicocele.

• #1 Varicocele: Varicose Veins in Testicles – Symptoms, Treatment – Urology | UCLA Health

  https://www.uclahealth.org/medical-services/urology/conditions-treated/male-conditions/varicocele-symptoms-treatment-diagnosis

  The varicocele can be identified on a routine physical exam when the testicles are felt while the male is in a standing position. […] Varicoceles that are smaller often are detected only on further testing, which can involve Doppler ultrasonography (ultrasound designed to detect the sound of backflow of the blood through the valve) and thermography (infrared sensing technology to detect pockets of heat created by the pooled blood).

• #1

  https://journals.lww.com/ajandrology/fulltext/2016/18020/diagnosis_of_clinical_and_subclinical_varicocele_.6.aspx

  In this review, we examine the evolution and application of various diagnostic modalities for varicoceles starting with venography, scintigraphy, and thermography and their role in the evaluation of a varicocele patient. […] The introduction of radiographic diagnostic studies has allowed for improved detection and further characterization of varicoceles. However, improved detection has generated a subset of subclinical varicoceles which are identified radiographically, but not appreciated on physical examination. […] The physical examination for varicocele is limited by its subjective nature in addition to patient body habitus. […] Compared to venography, physical examination was determined to have a sensitivity of 71% and a specificity of 69%. […] Ultrasound was found to be superior to Prader orchidometers with regards to testicular size estimation.

• #1 Causes of painless scrotal swelling in children and adolescents – UpToDate

  https://www.uptodate.com/contents/causes-of-painless-scrotal-swelling-in-children-and-adolescents

  VARICOCELE […] Clinical presentation and diagnosis […] The most common causes of painless scrotal swelling in children and adolescents include hydrocele and inguinal hernias that are not incarcerated. […] Less common causes are varicocele, spermatocele, localized edema from insect bites, nephrotic syndrome (swelling is usually bilateral), and rarely, testicular cancer (table 1). Scrotal swelling and testicular masses warrant prompt evaluation.

• #1 Varicoceles Diagnosis | Center for Male Reproductive Medicine & Microsurgery

  https://maleinfertility.org/procedures/microsurgical-varicocelectomy/diagnosis

  Varicoceles are graded I through III using the system outlined in Table 1. Grade I varicoceles are small, Grade II moderate and Grade III, large. Varicoceles should collapse in the supine position. If the varicocele remains prominent with the patient supine, this finding suggests a mechanical obstruction to testicular venous outflow from a retroperitoneal mass (sarcoma, lymphoma or a renal tumor with venous thrombus). An abdominal ultrasound or CT scan should be obtained to evaluate the retroperitoneum in these men. […] Scrotal ultrasonography with color flow Doppler imaging with the patient upright and supine may prove useful in equivocal cases or in patients with a body habitus that makes accurate physical examination of the scrotum impossible. Using ultrasonography, the diameter of the internal spermatic vein can be measured and retrograde flow through the vein during Valsalva maneuver documented. Veins that are greater than 3.5 mm can generally be detected on physical exam. Those that are 2.5 mm or larger but are not palpable and have been termed subclinical varicoceles. The need for diagnosing and treating subclinical varicoceles in controversial.

• #1 Varicocele – FV Hospital

  https://www.fvhospital.com/learn-more/varicocele/

  Ultrasound exam. Backward flow of blood in the swollen testicular veins is usually confirmed by ultrasound of the scrotum. […] A right-side-only varicocele is uncommon. In extremely rare cases, it might be caused by a tumour of the kidney. Ultrasound of the kidneys should be performed to rule it out.

• #1 Varicocele – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1103?locale=th

  A varicocele is an abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis. […] Diagnosis is usually clinical; ultrasound may be helpful where there is doubt about the diagnosis. […] Key diagnostic factors include painless scrotal mass, left-sided signs/symptoms, and small testicle. […] Other diagnostic factors include infertility, age 12, and scrotal or groin pain. […] 1st tests to order include clinical diagnosis. […] Tests to consider include scrotal ultrasound with color flow Doppler imaging, semen analysis, serum FSH (GnRH stimulation), serum testosterone, DNA fragmentation index (DFI), CT abdomen/pelvis, MRI abdomen/pelvis, and retroperitoneal ultrasound.

• #1 Adolescent Varicocele Diagnosis & Treatment – NYC | ColumbiaDoctors Children’s Health

  https://www.columbiadoctors.org/childrens-health/pediatric-specialties/urology/conditions-we-treat/adolescent-varicocele

  Varicoceles are varicose, or enlarged, veins in the scrotum. Varicoceles are usually found in adolescent boys on routine school or camp examinations and almost always produce no symptoms, although some boys complain of heaviness in the scrotum. […] Varicoceles are linked with stunted growth of the affected testicle and possible future infertility. Varicocele, the most common correctable cause of male infertility, is found in 30 to 50 percent of men with primary infertility. Varicocele repair can reverse the arrested growth of the testicle in adolescent boys and may protect their future fertility. It is important to note, however, that not all varicoceles have a negative impact on fertility.

• #1

• #1 Pillar | Medanta

  https://www.medanta.org/pillar/varicocele-types-symptoms-causes-diagnosis-treatment

  Varicocele is a condition where the veins in the scrotum, aka pampiniform venous plexus become enlarged. This enlargement happens when the valves within these veins do not work as they should, causing blood to pool and the veins to dilate. […] The diagnosis of varicocele typically involves a combination of medical history, physical examination, and other additional tests. The following are some diagnostic methods for varicocele: Medical history: Your doctor will ask questions about your symptoms, such as any pain or discomfort in the scrotum, symptoms duration, and any factors that may worsen or alleviate the symptoms. […] Physical assessment: The doctors physically examine the scrotum and testicles. They will carefully inspect and feel the scrotum while you are standing and lying down. The doctor may look for any signs of varicocele, such as enlarged or twisted veins, swelling, or a feeling of heaviness in the scrotum.

• #1 Varicocele | Men’s Health Center | Henry Ford Health – Detroit, MI

  https://www.henryford.com/services/urology/mens-health/fertility/varicocele

  Early, accurate diagnosis is key to successful treatment. […] If your doctor suspects you may have varicocele, the first step is a physical exam. Your doctor will feel both testicles to check for any abnormalities. We also sometimes use ultrasound to see the veins more clearly and confirm the diagnosis.

• #2 Varicocele Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/382288-overview

  Varicoceles develop as a result of dilatation and tortuosity of veins of the pampiniform plexus secondary to retrograde flow into the internal spermatic vein (ISV). A varicocele is a common abnormality, occurring in approximately 15% of men. Some patients may have scrotal pain and swelling, but more importantly, a varicocele is considered to be a potential cause of male infertility. […] The relationship between a varicocele and male infertility is controversial, but improved fertility and sperm quality have been reported after treatment, including occlusive treatment for varicoceles. On physical examination, large varicoceles are easily identified as the classic „bag of worms” surrounding the testis. Ultrasonography, particularly Doppler ultrasonography, allows accurate diagnosis of varicoceles, even subclinical varicoceles. Ultrasonography is the examination of choice for investigating varicoceles, and it remains the most practical and most accurate noninvasive technique.

• #2 Varicocele: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15239-varicocele

  Varicoceles are swollen veins in your scrotum. A healthcare provider can diagnose a varicocele and recommend the proper treatment. […] Varicoceles can affect fertility. Varicoceles can contribute to about 40% of all cases of male infertility. […] Talk to a healthcare provider if you suspect you have infertility. Fertility concerns are the top reason why people receive varicocele treatment. […] A healthcare provider can diagnose a varicocele. Theyll review your medical history, ask questions about your symptoms and perform a physical examination. […] They may also order the following tests to confirm their diagnosis: Pelvic ultrasound, Semen analysis, Blood test. […] After confirming the presence of a varicocele, your provider will grade its severity. […] If you have concerns about your ability to have a biological child, talk to a healthcare provider. Theyll help you understand your options. […] Talk to a healthcare provider if you have varicocele symptoms, including an inability to get your partner pregnant. They can diagnose a varicocele and recommend the best treatment for you.

• #2 Varicocele: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/varicocele

  How is a varicocele diagnosed? […] There are several ways that your doctor may diagnose a varicocele, including: […] Physical exam. Because a varicocele cant always be felt or seen when youre lying down, your doctor will most likely examine your testicles while youre standing up and lying down. […] Valsalva maneuver. This technique is often used to diagnose smaller varicoceles. The Valsalva maneuver typically requires you to stand, take a deep breath, hold it, and bear down while the doctor examines your scrotum. […] Scrotal ultrasound. In some cases, a scrotal ultrasound may be necessary. This helps measure the spermatic veins and allows your doctor to get a detailed, accurate picture of the condition. […] Once the varicocele is diagnosed, your doctor will classify it with one of three clinical grades. Theyre labeled grades 1 through 3, according to the size of the lump in your testicle. Grade 1 is the smallest, and grade 3 is the largest.

• #2 Varicoceles Diagnosis | Center for Male Reproductive Medicine & Microsurgery

  https://maleinfertility.org/procedures/microsurgical-varicocelectomy/diagnosis

  Varicoceles are graded I through III using the system outlined in Table 1. Grade I varicoceles are small, Grade II moderate and Grade III, large. Varicoceles should collapse in the supine position. If the varicocele remains prominent with the patient supine, this finding suggests a mechanical obstruction to testicular venous outflow from a retroperitoneal mass (sarcoma, lymphoma or a renal tumor with venous thrombus). An abdominal ultrasound or CT scan should be obtained to evaluate the retroperitoneum in these men. […] Scrotal ultrasonography with color flow Doppler imaging with the patient upright and supine may prove useful in equivocal cases or in patients with a body habitus that makes accurate physical examination of the scrotum impossible. Using ultrasonography, the diameter of the internal spermatic vein can be measured and retrograde flow through the vein during Valsalva maneuver documented. Veins that are greater than 3.5 mm can generally be detected on physical exam. Those that are 2.5 mm or larger but are not palpable and have been termed subclinical varicoceles. The need for diagnosing and treating subclinical varicoceles in controversial.

• #2 Varicocele – Wikipedia

  https://en.wikipedia.org/wiki/Varicocele

  A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum; in a woman, it is an abnormal painful swelling to the embryologically identical pampiniform venous plexus; it is more commonly called pelvic compression syndrome. […] Varicocele is sometimes discovered when investigating the cause of male infertility. […] Following discovery of the sign of swelling comprising a mass, varicocele can be confirmed with scrotal ultrasound, which will show dilation of the vessels of the pampiniform plexus to be greater than 2.3 mm. […] A universally accepted system for categorizing varicoceles does not exist, but according to the classification criteria established in 1970 by Dubin and Amelar, most commonly varicoceles are clinically assessed and categorized into three grades as follows:

• #2 Varicocele Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/382288-overview

  CT scanning with increased intra-abdominal pressure can be used as a noninvasive method to detect a varicocele and to show proximal extension of the lesion into the inguinal canal. […] On MRIs, a varicocele is demonstrated as a mass of dilated serpiginous vessels, usually adjacent to the epididymal head. […] Ultrasonographic findings of varicoceles include tortuous anechoic tubular structures adjacent to the testis. […] Ultrasonography has been reported to have a 97% sensitivity and 94% specificity for the diagnosis of clinical varicocele. […] Color Doppler ultrasonographic imaging can be helpful in differentiating venous channels from epidermoid cysts or spermatoceles when doubt exists. […] Tissue elastography ultrasound measures the stiffness of tissue. According to Dede et al, acoustic radiation force impulse (ARFI) elastography can measure early damage of testicular structure by varicoceles.

• #2 Varicocele Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/382288-overview

  The existence of veins larger than 2 mm is a commonly used ultrasound criterion for diagnosing varicocele, with a sensitivity of 95%. […] Functional MRI techniques, such as diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI, and MR spectroscopy have been shown to provide important diagnostic information for diagnosing testicular diseases. […] Venography is the most reliable modality for the detection of subclinical varicoceles, because the findings demonstrate abnormal retrograde flow into the spermatic veins or pampiniform plexus. […] Although the diagnosis and management of varicoceles have not been standardized, there are many published guidelines available, such as those by the American Society of Reproductive Medicine, American Urological Association, European Association of Urology, and World Health Organization.

• #2 Varicocele Embolization for Infertility – Endovascular Today

  https://evtoday.com/articles/2017-apr/varicocele-embolization-for-infertility

  A varicocele is a collection of varicose veins within the pampiniform (spermatic) plexus secondary to reflux in the internal spermatic vein (ISV). The condition affects 10% to 15% of the general population but is detected in as many as 40% of men undergoing an infertility workup. […] Traditionally, the diagnosis was made through clinical examination; however, as with other venous reflux disorders, ultrasound has become the mainstay of diagnosis. […] For diagnosis, we look for abnormal reflux on color Doppler with the Valsalva maneuver, rather than the diameter and number of dilated veins, as venous diameter varies significantly with the patients levels of hydration, anxiety, and inspiratory effort. […] A diagnosis of varicocele is confirmed if veins are 2 mm in diameter and there is an abnormally brisk and prolonged accentuation of flow with the Valsalva maneuver.

• #2

  https://journals.lww.com/ajandrology/fulltext/2016/18020/diagnosis_of_clinical_and_subclinical_varicocele_.6.aspx

  Despite these limitations, physical examination still represents the gold standard for diagnosing clinically significant varicoceles, which have the clearest indications for repair. […] Scrotal ultrasound is currently the most established and widely used modality for the study of varicoceles. […] Given its high sensitivity and specificity (97% and 94% when compared to venography), noninvasive nature, and relative ease of performance, scrotal ultrasound with Doppler examination has become the study of choice in evaluating scrotal and testicular pathology. […] The most recent AUA and ASRM guidelines do not recommend the routine use of scrotal ultrasound to diagnose varicoceles. Instead, the role of scrotal ultrasound is reserved for situations in which physical examination is inconclusive, such as patients with large body habitus or thick scrotal skin precluding accurate examination. […] The widespread use of scrotal ultrasound, however, has resulted in increased detection of subclinical varicoceles.

• #2 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/kju.2015.56.2.144

  In this study, we proposed to assess the effectiveness of the Valsalva maneuver and the standing position on CDU for varicocele diagnosis and to devise a new index that can improve existing diagnostic criteria of CDU for varicocele. […] CDU is a useful modality for scrotal varicocele diagnosis but limitations do exist. The detection of varicocele is more precise with the patient in the standing position, and the Valsalva maneuver has a greater role in dilation of the pampiniform plexus in the standing position than in the supine position. The resting-Valsalva ratio in the standing position could be a new and ancillary diagnostic index for varicocele diagnosis by use of scrotal CDU.

• #2 How Serious Is a Varicocele Diagnosis? azura-logo-white

  https://www.azuravascularcare.com/infovaricocele/is-a-varicocele-diagnosis-serious/

  The doctor said you have a varicocele, but how serious is it? It’s an obvious question any man would ask when presented with a varicocele diagnosis. […] If you have a varicocele, then there are some things you should know about your diagnosis. […] Varicoceles are responsible for about 40 percent of all male infertility. […] A varicocele diagnosis often comes with varicocele grades that provide additional information about the seriousness of the condition. […] Once the diagnosis is made, your doctor will discuss the treatment options with you, including surgical procedures that require hospitalization, possibly general anesthesia, and a longer recovery period. […] If you are considering nonsurgical treatment options for your varicocele diagnosis, call 866.705.VEIN (8346) today to schedule an appointment with a vascular specialist.

• #2 Varicoceles Diagnosis | Center for Male Reproductive Medicine & Microsurgery

  https://maleinfertility.org/procedures/microsurgical-varicocelectomy/diagnosis

  A recent meta-analysis by Marmar et al. clearly shows a significant increase in pregnancy rates after microsurgical varicocelectomy. […] A multi-center WHO study on the influence of varicocele on fertility parameters demonstrated that the mean testosterone (T) concentration of men older than 30 years of age with varicoceles was significantly lower than that of younger patients with varicoceles, whereas this trend was not seen in men without varicoceles. […] Repairing varicoceles appears to improve serum testosterone (T) levels. […] The abnormalities of semen parameters in infertile men with varicocele were first objectively described by Macleod in 1965. […] A large number of studies have evaluated the effects of varicocelectomy on semen parameters. Most of these studies have demonstrated an improvement in sperm density with or without a concomitant increase in sperm motility and morphology after varicocelectomy, suggesting a cause and effect relationship between varicocele and abnormal semen parameters. […] The impact of the grade of varicocele on the magnitude of improvement in semen quality after varicocelectomy is not surprising.

• #2 Varicocele | UNC Department of Urology

  https://www.med.unc.edu/urology/patientcare/adult-non-cancer/male-fertility/varicocele/

  The resultant improvement in semen quality occurs in close to 70% of patients, and the pregnancy rate is as high as 40%. Correction of varicoceles has been shown to improve sperm motility, density, and shape (morphology), but also specific functional sperm defects including oxidative damage (ROS) and breaks in DNA. […] The scrotal varicocele remains the most correctable factor when treating poor semen quality. Therefore, when present in the infertile male who demonstrates abnormalities of semen quality, surgical correction should be strongly considered.

• #2 Varicocele: Causes, Symptoms, and Diagnosis

  https://www.urology-textbook.com/varicocele.html

  A varicocele is defined as ectatic and tortuous veins of the pampiniform plexus of the spermatic cord. […] Varicocele is common; approximately 411% of adult males have a varicocele by clinical examination. […] The prevalence is up to 30% when Doppler sonography is used for varicocele diagnosis. […] Signs of varicocele are ectatic veins in the spermatic cord (venous diameter of more than 3.5 mm) and a reduced testicular size (difference 20% or 2 ml). […] It is essential to exclude testicular or retroperitoneal tumors. […] Pathological findings in semen analysis (oligozoospermia, asthenozoospermia, teratozoospermia) and DNA fragmentation of spermatozoa are possible. […] The grading of varicocele correlates with markers of subfertility: for example, up to 55% of men with grade III varicocele have a pathological semen analysis. […] An elevated FSH and low testosterone are typical for a testicular dysfunction due to a high-grade varicocele.

• #2 Varicocele Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/382288-overview

  Technetium-99m (99mTc) labeled red blood cells are the radiopharmaceutical agent of choice for the evaluation of varicoceles, although other radionuclides have been used as well. […] Venography is the most reliable modality for the detection of small or subclinical varicoceles, because findings demonstrate abnormal venous blood reflux in a retrograde fashion into the internal spermatic vein (ISVs) and the pampiniform plexus.

• #2 Varicocele – FV Hospital

  https://www.fvhospital.com/learn-more/varicocele/

  Ultrasound exam. Backward flow of blood in the swollen testicular veins is usually confirmed by ultrasound of the scrotum. […] A right-side-only varicocele is uncommon. In extremely rare cases, it might be caused by a tumour of the kidney. Ultrasound of the kidneys should be performed to rule it out.

• #2 Varicocele: Varicose Veins in Testicles – Symptoms, Treatment – Urology | UCLA Health

  https://www.uclahealth.org/medical-services/urology/conditions-treated/male-conditions/varicocele-symptoms-treatment-diagnosis

  The varicocele can be identified on a routine physical exam when the testicles are felt while the male is in a standing position. […] Varicoceles that are smaller often are detected only on further testing, which can involve Doppler ultrasonography (ultrasound designed to detect the sound of backflow of the blood through the valve) and thermography (infrared sensing technology to detect pockets of heat created by the pooled blood).

• #2 Varicocele: Causes, Symptoms, and Treatment

  https://patient.info/mens-health/scrotal-lumps-pain-and-swelling/varicocele

  A varicocele is like varicose veins of the small veins (blood vessels) next to one testicle (testis) or both testicles (testes). […] Varicoceles can be diagnosed by a doctor examining the testicles and scrotum. A colour duplex ultrasound scan (a scan using ultrasound to look at blood flow in an area) is sometimes also done to confirm the diagnosis. […] It’s very rare for a varicocele to be caused by anything serious. Further tests to look for serious problems usually aren’t necessary, but may be recommended if: The varicocele has developed for the first time after the age of 40. […] Varicoceles are thought to be one of the most common causes of male infertility. However, most men with varicoceles are still fertile – infertility seems to only affect around 10-20% of men with a varicocele.

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