From the Guidelines
Given the presence of a small left lateral varicocele with an otherwise normal scrotal ultrasound examination, treatment is not recommended unless the patient is experiencing symptoms such as pain, discomfort, or fertility issues, as the routine use of ultrasonography to investigate presumed varicocele is discouraged in asymptomatic males 1. The patient's varicocele is described as small, and according to the guidelines, treatment of non-palpable varicoceles is not associated with improvement in either semen parameters or fertility rates 1. Some key points to consider in the management of varicoceles include:
- Scrotal ultrasound can be used to confirm the presence of varicocele and to determine procedural success after correction, in the context of shared decision-making with the patient 1.
- Clinicians should not perform transrectal ultrasonography (TRUS) or pelvic MRI as part of the initial evaluation of the infertile male, unless there is suspicion of ejaculatory duct obstruction (EDO) 1.
- The World Health Organization Reference Limits for Human Semen Characteristics provide a framework for evaluating semen parameters, including semen volume, total sperm number, sperm concentration, vitality, progressive motility, total motility, and morphologically normal forms 1. In this case, since the varicocele is small and the rest of the scrotal ultrasound is normal, observation is typically recommended with follow-up in 6-12 months to monitor for any changes in size or symptoms 1.
From the Research
Varicocele Diagnosis and Treatment
- A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venous plexus within the spermatic cord 2.
- The prevalence of varicocele is reported to be approximately 15% in the general male population, with its incidence increasing with age and having a higher incidence in infertile men 3.
- Varicocele treatment (surgical or interventional) is considered one of the most common therapies of reversible infertility in men 3.
Treatment Options
- Percutaneous embolization offers a nonsurgical, minimally invasive option for the treatment of varicoceles, requiring only minimal sedation 3.
- Surgical correction is also a common treatment option, with microsurgical subinguinal varicocele repair being the current surgical standard 4.
- Laparoscopy is another treatment option, often used in adolescent varicocele treatment 2.
Indications for Treatment
- A semen analysis should be obtained for any male patient of reproductive age considering intervention 4.
- Testicular atrophy is a common indication for varicocele repair, particularly in adolescent males 2.
- Pain and reduced fertility rates are also associated with varicoceles and may be indications for treatment 5.