ia_gov_sa · guide · processed · 2 chunks
Background Evaluation Management vocal Council of Health Insurance Approach to VARICOCELE in Adults الجمعيه السعوديه لطب الاسره والмеجital Saudi Society of Family and Community Medicine <table><tr><td>Background</td><td colspan="2">•Vascular lesion characterized by the dilation of gonadal veins in the scrotum, sometimes described as having a "bag of worms" appearance.•Prevalence in adult men is about 15% overall, but may reach up to 40% in men attending infertility clinics.•Affects adolescents and young adult men</td></tr><tr><td rowspan="3">Evaluation</td><td>Clinical Presentation</td><td>•Most varicoceles are asymptomatic •Symptoms suggest secondary varicocele*•Painless scrotal swelling•Dull, aching, usually left-sided scrotal pain•Infertility</td></tr><tr><td>Diagnosis</td><td>•Should be attended in supine and standing positions, both with and without Valsalva maneuver (which helps in dilating varicocele and makes it more obvious)•Includes assessment of testicular size and consistency</td></tr><tr><td>Treatment</td><td>The grading system used by Dubin and Amelar, based on the clinical features•Subclinical: Not palpable or visible at rest or during Valsalva but detectable on US•Grade I (Small size): Palpable during Valsalva maneuver•Grade II (Medium size): Palpable at rest, but not visible.•Grade III (Large size): Visible and palpable at rest.</td></tr><tr><td rowspan="2">Management</td><td>Testing</td><td>•Routine semen analysis, typically performed twice•Ultrasound is the imaging modality of choice (consider diagnostic if venous diameter ≥3 mm)•If patient's presentation suggest secondary varicocele, consider different imaging modality (US, CT or MRI) of abdomen</td></tr><tr><td colspan="2"><img></td></tr></table> References 1) Mohammed A, Chinegwundoh F. Testicular varicocele: an overview. Urol Int. 2009;82(4):373-379. doi:10.1159/000218523 2) Practice Committee of the American Society for Reproductive Medicine; Society for Male Reproduction and Urology. Report on varicocele and infertility: a committee opinion. Fertil Steril. 2014;102(6):1556-1560. doi:10.1016/j.fertnstert.2014.10.007 3) Report on varicocele and infertility, (AUA) and the Practice Committee of the American Society for Reproductive Medicine (ASRM). 4) Freeman, S. et al. “Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading.” European Radiology 30 (2019): 11-25. 4) Dynamed