What Are Some Criteria For Varicocele Evaluation?
Discussion
Varicoceles are caused by high venous back pressure which causes a tortuous dilatation of the testicular veins (pampiniform plexus) of the spermatic cord. They occur more on the left than right because the left renal vein has a higher pressure than the inferior vena cava which drain the left and right gonadal veins respectively. Varicoceles are not very common in young children (3% in < 10 years old) but increase during the adolescent years when the incidence is ~15% which is similar to the adult population. Most varicoceles do not cause problems, but can. The most worrisome problem is male infertility. "It is estimated that 85% of men with varicocele will not encounter male factor infertility." However for those with male factor infertility, varicocele occurs in up to 40% of men. "In contrast, most adolescents who present with varicocele are asymptomatic and their fertility future is unknown." Therefore evaluation and management for adolescent males with asymptomatic varicocele is controversial.
Varicoceles should reduce in size when the patient is supine. If the varicocele does not reduce when supine, a pelvic/abdominal mass should be considered. Varicoceles are graded with the patient standing:
i. Palpable with valsalva
ii. Palpable at rest
iii. Grossly visible
Subclinical varicoceles are those that are found incidentally such as scrotal ultrasound. Subclinical varicoceles do not have an impact on fertility but can progress over time ...
Source: PediatricEducation.org - Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news
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