Varicocele Clinical Diagnosis and Grading

Abstract

Varicocele is a common condition in men and is the most surgically correctable cause of male infertility. Proper clinical diagnosis of varicocele is important to avoid overdiagnosis which may lead to unnecessary treatment by varicocelectomy or underdiagnosis which may delay treatment of patients. Clinical diagnosis of varicocele depends upon clinical presentation and physical examination and may be aided by radiological investigations. Generally, varicocele is asymptomatic and is only accidentally discovered during the physical examination of infertile men, athletes, or army recruits. However, varicocele may present with dull aching testicular pain, scrotal swelling, and rarely hypogonadism. Physical examination is the cornerstone for diagnosis of varicocele as recommended by the majority of international guidelines although it may be biased by lack of physician expertise or changes in body structure as seen in obese or men with tight scrotal sac. In case of uncertainty, radiological examination, commonly scrotal Doppler ultrasound, may be used to confirm the diagnosis.