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Varicocele

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  1. Epidemiology
    1. Present in 20% of all males
    2. Occurs in 30% of infertile men
      1. Most common correctable form of Male Infertility
  2. Symptoms
    1. Often asymptomatic
    2. Patient finds mass lying posterior and above the Testes
    3. Red Flag: Sudden onset varicocele in older man
      1. Left: Assess renal tumor and spermatic vein occlusion
      2. Right: Assess vena cava obstruction
  3. Signs
    1. "Bag of worms" superior to the Testicle
    2. Vein dilation and tortuosity
      1. Decreased with patient supine
      2. Increased with patient upright and with valsalva
    3. Left varicocele most common
      1. Left testicular vein drains into renal vein
  4. Pathophysiology
    1. Abnormal venous tortuosity and dilatation
      1. Pampiniform venous plexus
      2. Internal spermatic vein
    2. Associated Infertility may be due to
      1. Elevated testicular temperature
      2. Results in decreased spermatogenesis and motility
  5. Management: Surgical repair
    1. Indication
      1. Abnormal seman analysis and Infertility
        1. Fails to Restore fertility by recent study
          1. Evers (2003) Lancet 361:1849
      2. Persistant symptoms (Dull ache or heavy sensation)
    2. Procedures
      1. Surgical ligation of pampiniform plexus
      2. Injected sclerotherapy
      3. Directed embolization via intervention radiology

Varicocele (C0042341)

Definition (MSH)A condition characterized by the dilated tortuous veins of the SPERMATIC CORD with a marked left-sided predominance. Adverse effect on male fertility occurs when varicocele leads to an increased scrotal (and testicular) temperature and reduced testicular volume.
ConceptsDisease or Syndrome (T047)
ICD9456.4, 456.4
MSHD014646
EnglishScrotal varices, Scrotal varices - varicocele, Varicocele, Varicoceles
Spanishvarices escrotales, varicocele
Parent ConceptsVarices of other sites (C0155797), Genital Diseases, Male (C0017412), Vascular Diseases (C0042373), Varicosity (C0042345), Pelvic varices (C0155795), Disorder of spermatic cord (C0403795), Vascular disorder of scrotum (C1299540), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesCOSTAR, CSP, DXP, ICD9CM, LCH, MSH, MTHICD9, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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