Guidelines for the assessment of male varicocele

Varicocele is caused by a disorder of the venous drain- age of the testicle with consequent formation of varicose veins of the pampiniform plexus surrounding the testicle inside the scrotum. The incidence of varicocele is roughly 10-15% in the overall population and 20-40% in infertile men. The left side is involved in 85% of the cases. Varicocele mostly ap- pears with puberty and is multifactorial in nature. There is a family component since a “weakness” of the venous valves is inherited, which can also be the cause for haemor- rhoids and varicose veins of the lower limbs. Those diseases are often present in brothers and parents. There is also an embryogenetic de- velopment that may lead to the absence or incompetence of the valves along the spermatic veins. Another factor may be compression of the left renal vein by the superior mesenteric artery on the aorta In many cases varicocele presents asymptomatically. In some cases it is accompanied by a sense of inguinoscrotal heaviness on the side involved, which is worse in evening hours and enhanced by standing a long time or after physical exertion. In most cases, particularly in young adults, varicocele is identified during workups undertaken for infertility. The seminal examination shows: reduction of sperm motility and number plus changes of their morphology. Damage to fertility is slowly progressive. Diagnosis should be done as early as possible.The assessment of varicocele is based on two investigations: the CDS of the spermatic vessels, which is the only safe device to show the venous reflux necessary for defining varicocele and the spermiogram, i.e. the quantitative and qualitative analysis of sperm. The testicular US investigation measures the testicular volumes and also shows distension of the veins of the pampiniform plexus. CDS allows the varicocele condition. There is no medical treatment. The treatment is open surgical (selective ligature of the spermatic vein) or endovascular (percutaneous catheterization and sclerosis of the spermatic vein).Recurrences of the disease after correction are in 5 to 20% of the cases.A follow-up at one and six months is adviced measuring the venous reflux.