Varicocele: Difference between revisions

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=== History and Physical Exam ===

* '''Physical Exam'''

** '''Examine the patient in both the supine and standing positions.''' '''The veins should decompress in the supine position~~; failure~~ to do so, particularly on the right side, ~~warrants evaluation (CT or sonogram) for~~ an abdominal or pelvic mass.~~'''~~

** '''Examine the patient in both the supine and standing positions.''' '''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.

***2020 AUA Guidelines on Infertility:

** '''Testicular consistency''' should be assessed; the affected testis may be soft.

** '''Measurement of testicular volume''' is important because it may predicate surgical intervention

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=== Imaging ===

*'''Abdominal/pelvic CT or US'''

**'''~~Indicated if veins do not decompress in the supine position, particularly~~ on the right ~~side~~.'''

**'''Routine imaging based solely on the presence of a right varicocele is unnecessary.[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''

**'''Abdominal imaging should be considered for men with a new onset or non-reducible varicocele, especially if varicocele is large[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''

== Management ==

@@ Line 45: / Line 45: @@
 === History and Physical Exam ===
 * '''Physical Exam'''
-** '''Examine the patient in both the supine and standing positions.''' '''The veins should decompress in the supine position; failure to do so, particularly on the right side, warrants evaluation (CT or sonogram) for an abdominal or pelvic mass.'''
+** '''Examine the patient in both the supine and standing positions.''' '''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.
+***2020 AUA Guidelines on Infertility:
 ** '''Testicular consistency''' should be assessed; the affected testis may be soft.
 ** '''Measurement of testicular volume''' is important because it may predicate surgical intervention
@@ Line 51: / Line 53: @@
 === Imaging ===
 *'''Abdominal/pelvic CT or US'''
-**'''Indicated if veins do not decompress in the supine position, particularly on the right side.'''
+**'''Routine imaging based solely on the presence of a right varicocele is unnecessary.[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
+**'''Abdominal imaging should be considered for men with a new onset or non-reducible varicocele, especially if varicocele is large[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
 == Management ==