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Varicocele

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/ESPU 2023), the European Association of Urology (EAU 2023), the Canadian Urological Association (CUA 2023), the American Urological Association (AUA/ASRM 2021), and the American Society for Reproductive Medicine (ASRM 2014).
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Guidelines

1.Screening and diagnosis

Diagnosis
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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2.Diagnostic investigations

Scrotal imaging: as per EAU 2023 guidelines, obtain scrotal ultrasound to detect venous reflux without Valsalva maneuvre 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

3.Surgical interventions

Indications for varicocelectomy: as per CUA 2023 guidelines, consider offering observation rather than performing varicocelectomy in patients with varicoceles and testicular failure non-obstructive azoospermia considering surgical sperm retrieval and IVF-intracytoplasmic sperm injection.
C

4.Specific circumstances

Pediatric and adolescent patients, evaluation: examine varicocele in the standing position and classify into three grades:
Situation
Guidance
Grade I
Small size, palpable only at Valsalva maneuvre
Grade II
Medium size, palpable without Valsalva maneuvre
Grade III
Large size, visible at distance
B
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  • Pediatric and adolescent patients (management)