Evaluation

evaluation

Most patients are usually asymptomatic (1). In adolescents, it may be noticed by the patient or his parents, or discovered by the pediatrician at a routine physical exam (2).

• other patients may complain of a dull ache at the end of the day or following exercise.

Physical examination of the patient should be completed in both sitting and standing positions inside a warm and comfortable room.

• inspect the scrotum first and then palpate to evaluate spermatic cord and testes
  • a diagnosis is made by observing and/or palpating a dilated or tortuous segment
  • a palpable varicocele feels like a "bag of worms" and disappears or is very significantly reduced when the patient is recumbent
    
    
• if the varicocele is not clearly palpable, patient should be instructed to perform the Valsalva maneuver in a standing position which increases the dilation
  
  
• the following classification of varicocele can be used in clinical practice:
  • subclinical - not palpable or visible at rest or during Valsava manoeuvre, but can be shown by special tests (doppler ultrasound studies)
  • grade 1 - palpable during Valsava manoeuvre, but not otherwise
  • grade 2 - palpable at rest, but not visible
  • grade 3 - visible and palpable at rest (3)

Scrotal ultrasonography can be used to assist the diagnosis

• specially helpful when the diagnosis is inconclusive e.g. in patients with morbid obesity, previous scrotal surgery or accompanying ipsilateral hydrocele (4)

Reference:

1. Shridharani A, Owen RC, Elkelany OO, Kim ED. The significance of clinical practice guidelines on adult varicocele detection and management. Asian Journal of Andrology. 2016;18(2):269-275.
2. Waalkes R et al. Varicocele in adolescents: a review and guideline for the daily practice. Arch Esp Urol. 2012;65(10):859-71
3. European Association of Urology (EAU) 2015. Guidelines in male infertility.
4. Sener NC et al. Varicocele: A review. EMJ Repro Health. 2015;1[1]:54-58