Varicocele: Difference between revisions
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== Associated Pathologic Processes == | == Associated Pathologic Processes == | ||
* '''Can impair testicular growth and | * '''Can impair testicular growth and fertility with a progressive and duration-dependent decline by interrupting counter-current heat exchange provided by pampinoform plexus, resulting in increased testicular temperature''' | ||
*# '''Testicular growth''' | *# '''Testicular growth''' | ||
*#* “Catch-up” growth, defined as normalization of left relative to right testicular size, occurs in 32-83% of patients after varicocele repair | *#* “Catch-up” growth, defined as normalization of left relative to right testicular size, occurs in 32-83% of patients after varicocele repair | ||
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=== History and Physical Exam === | === History and Physical Exam === | ||
* '''Physical Exam''' | * '''<span style="color:#ff0000">Physical Exam''' | ||
** '''Examine the patient in both the supine and standing positions.''' '''The veins should decompress in the supine position''' | ** '''<span style="color:#ff0000">Genitals''' | ||
***Failure to do so, particularly on the right side, may be from an abdominal or pelvic mass. | ***'''<span style="color:#ff0000">Scrotum''' | ||
** '''Testicular | ****'''<span style="color:#ff0000">Examine the patient in both the supine and standing positions, with and without Valsalva.''' '''The veins should decompress in the supine position''' | ||
** ''' | *****Failure to do so, particularly on the right side, may be from an abdominal or pelvic mass. | ||
**** '''Testicular''' | |||
*****'''Consistency'''; affected testis may be soft | |||
***** '''Volume;''' may predicate surgical intervention | |||
=== Imaging === | === Imaging === | ||
*'''Abdominal/pelvic CT or US''' | *'''Abdominal/pelvic CT or US''' | ||
**''' | **'''Indications''' | ||
**''' | ***'''<span style="color:#ff0000">Consider for males with a new onset or non-reducible varicocele, especially if varicocele is large[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]''' | ||
***'''Routine imaging based solely on the presence of a right varicocele is unnecessary.[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]''' | |||
== Management == | == Management == | ||
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* '''Avoided because damage to the arterial supply of the testis frequently results in testicular atrophy and further impairment of spermatogenesis and fertility''' | * '''Avoided because damage to the arterial supply of the testis frequently results in testicular atrophy and further impairment of spermatogenesis and fertility''' | ||
===== | ===== Adverse Events ===== | ||
# '''Failure (varicocele persistence or recurrence''') | # '''<span style="color:#ff0000">Failure (varicocele persistence or recurrence</span>''') | ||
# '''Hydrocele''' formation after varicocelectomy is caused by lymphatic obstruction | # '''<span style="color:#ff0000">Hydrocele</span>''' formation after varicocelectomy is caused by lymphatic obstruction | ||
# '''Injury or ligation of the testicular artery''' carries with it the risk of testicular atrophy and/or impaired spermatogenesis | # '''<span style="color:#ff0000">Injury or ligation of the testicular artery</span>''' carries with it the risk of testicular atrophy and/or impaired spermatogenesis | ||
# | #* '''UrologySchool.com Summary''' | ||
#** '''High rates of varicocle recurrence: retroperitoneal and radiographic''' | |||
# | #** '''High rates of hydrocele: retroperitoneal, laparoscopic, and conventional inguinal''' | ||
# | #** '''Artery not preserved: retroperitoneal and conventional inguinal''' | ||
# | |||
== References == | == References == | ||