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Varicocele

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of varicocele are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2024), the Canadian Urological Association (CUA 2023), the European Association of Urology (EAU/ESPU 2023), the American Urological Association (AUA/ASRM 2021), and the American Society for Reproductive Medicine (ASRM 2014).
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Screening and diagnosis

Diagnosis
As per ASRM 2014 guidelines:
Diagnose varicocele based primarily on physical examination. Obtain imaging only when physical examination is inconclusive.
E
Recognize that only clinically palpable varicoceles have been clearly associated with infertility.
E
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Diagnostic investigations

Scrotal imaging: as per EAU/ESPU 2023 guidelines, obtain scrotal ultrasound to detect venous reflux without Valsalva maneuver in the supine and upright position and to discriminate testicular hypoplasia in pediatric and adolescent patients with varicocele.
A
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  • Abdominal imaging

Surgical interventions

Indications for varicocelectomy: as per EAU 2024 guidelines, do not treat varicocele in infertile men who have normal SA and in men with a subclinical varicocele.
D
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Specific circumstances

Pediatric and adolescent patients, evaluation: as per EAU/ESPU 2023 guidelines, examine varicocele in the standing position and classify it into three grades:
Situation
Guidance
Grade I
Small size, palpable only at Valsalva maneuver
Grade II
Medium size, palpable without Valsalva maneuver
Grade III
Large size, visible at distance
B
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  • Pediatric and adolescent patients (management)