📖 What is a varicocele?
A varicocele is an abnormal dilation of the veins of the pampiniform plexus within the scrotum — essentially varicose veins around the testicle. It is present in 15% of the general male population and up to 40% of men presenting for infertility assessment.
Varicoceles most commonly affect the left side (90%), due to the right-angle drainage of the left testicular vein into the left renal vein (compared to the oblique angle on the right). Bilateral varicoceles occur in ~15% of cases.
🎯 Symptoms
- A dull ache or heaviness in the left scrotum, worse when standing or after exercise
- A visible or palpable "bag of worms" above the testicle
- Male infertility — reduced sperm count, motility, or morphology (oligoasthenoteratospermia)
- May be asymptomatic — discovered incidentally during fertility workup
🔧 Diagnosis
🔬 Clinical grading (Dubin & Amelar)
Grade I: palpable on Valsalva only. Grade II: easily palpable. Grade III: visible. Clinical examination should be performed standing with the patient performing the Valsalva manoeuvre.
📊 Scrotal ultrasound & Doppler
Confirms the diagnosis, assesses venous diameter (>3 mm pathological), demonstrates reflux on Doppler. Essential before treatment to exclude other pathology.
🧪 Semen analysis (spermogram)
Mandatory before treatment. Assesses sperm concentration, progressive motility, and morphology. Repeated 3 and 6 months after embolization.
🩻 Hormonal panel
FSH, LH, testosterone. Elevated FSH suggests testicular damage. Low testosterone may require separate treatment.
🔗 Related pages
🇫🇷 French version: varicocele-definition.html