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Varicocele and Orchialgia

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Varicocele and Male Infertility

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Abstract

A varicocele is the abnormal dilation and tortuosity of the pampiniform plexus of veins in the spermatic cord. Varicoceles affect approximately 15% of the male population. While the majority of men with varicoceles are asymptomatic, about 10% of patients may experience pain. The pain associated with varicoceles is typically restricted to the ipsilateral scrotum, is described as dull and achy, and is typically exacerbated by prolonged periods of standing or activity. A varicocele implicated as the etiology of chronic orchialgia is a diagnosis of exclusion, and a thorough history and physical examination must be performed to rule out other causes of pain, paying particular attention to atypical signs or symptoms. Adjunctive studies such as urinalysis and urine culture should be obtained if indicated. Though imaging is not necessary or indicated for the diagnosis of varicocele, several imaging modalities including ultrasound, CT, and MRI are often useful in the evaluation of other potential causes of chronic orchialgia. Additionally, given the known effect of varicoceles on fertility, a thorough sexual and reproductive history should be obtained, and a fertility evaluation should be offered. Initial management for suspected varicocele-related orchialgia should be aimed at conservative measures, including nonsteroidal anti-inflammatory (NSAIDs) drugs or medications, scrotal support, activity limitations, and a 6-month-long period of observation to allow other sources of pain to present themselves or resolve. If conservative measures fail to adequately manage the pain, or if activity limitations are not feasible, procedural intervention may be indicated. While the microsurgical subinguinal approach is the gold standard, surgical repair has been shown to be effective in treating varicocele-related chronic orchialgia, regardless of approach, with approximately 90% of patients experiencing significant improvement or complete resolution of pain with infrequent and mild complications.

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Authors and Affiliations

  1. Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Benjamin J. McCormick & R. Matthew Coward

Authors
  1. Benjamin J. McCormick
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  2. R. Matthew Coward
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Editor information

Editors and Affiliations

  1. ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, São Paulo, Brazil

    Sandro C Esteves

  2. S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Chak-Lam Cho

  3. Department of Urology, Hamad Medical Corporation, Weill Cornell Medicine Qatar, Doha, Qatar

    Ahmad Majzoub

  4. Department of Urology, Cleveland Clinic, Cleveland, OH, USA

    Ashok Agarwal

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McCormick, B.J., Coward, R.M. (2019). Varicocele and Orchialgia. In: Esteves, S., Cho, CL., Majzoub, A., Agarwal, A. (eds) Varicocele and Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-79102-9_14

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  • DOI: https://doi.org/10.1007/978-3-319-79102-9_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-79101-2

  • Online ISBN: 978-3-319-79102-9

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