Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_66
© Springer International Publishing Switzerland 2014
Varicocele
(1)
Department of Urology, Geisinger Medical Center, 100 N. Academy Av. MC 13-16, Danville, PA 17822, USA
(2)
Department of Pediatric Urology, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 13-16, Danville, PA 17822, USA
Abstract
A varicocele represents dilated internal spermatic veins within the spermatic cord which can be palpated on physical exam.
A varicocele represents dilated internal spermatic veins within the spermatic cord which can be palpated on physical exam.
1.
Pathophysiology:
(a)
Incidence: 15 % of the adult male population has a varicocele which is often asymptomatic.
(i)
Varicoceles are typically seen around the onset of puberty and are noted with increasing incidence with increasing Tanner stage.
(ii)
Most varicoceles are left-sided or bilateral.
(b)
Pathophysiology thought to be related to multiple etiologies.
(i)
Angle of insertion of left gonadal vein into renal vein.
(ii)
Elevated hydrostatic pressure (longer left gonadal vein).
(iii)
Incompetence of venous valves.
(c)
Natural history may range from asymptomatic to symptomatic with testicular atrophy and subfertility.
(i)
Effects are thought to be secondary to elevated scrotal temperature with varicocele but exact reason remains unclear.
2.
Clinical presentation:
(a)
Often incidental finding on physical exam, especially sports physicals.
(b)
Testicular pain (uncommon).
(c)
Scrotal/testicular masses, swelling, or asymmetry.
3.
Physical examination:
(a)
Scrotal examination:
(i)
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Spermatic cord:
1.
Palpate each spermatic cord in upper scrotum for varicocele (may feel like a “bag of worms” on exam).
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