Diagnoses of Varicocele

There are other causes of a mass developing in the scrotum and other conditions that will cause pain in the scrotum.  That is why it is always best to have the mass or the pain checked out by a medical professional to confirm if it is a varicocele or another ailment.

The mainstay of varicocele diagnoses is physical examination and Doppler ultrasonography.

1. History and physical examination

The diagnoses can be made by an experienced health care provider after careful history and examination of the patient and then confirmed with ultrasound. Physical examination should always be performed before any special investigations.

The health care provider will examine the groin area which includes the scrotum and testes while the patient is in the upright position. A varicocele feels like a twisted mass of veins along the spermatic cord or like a bag of worms as mentioned.  A varicocele is difficult to detect with the patient is lying down.

Valsalva Maneuver

Valsalva Maneuver

If the varicocele cannot easily be palpated the healthcare provider might ask the patient to increase his intra-abdominal pressure by performing the Valsalva maneuver.  (This maneuver is performed by exhaling against a closed airway, usually achieved by pinching one’s nose closed while blowing against the back of one’s hand, as if trying to blow up a balloon.)

 

 

orchidometer

Orchidometer

The testicle on the affected side may also feel smaller than the unaffected one due to atrophy. The size of the testis can be assessed by using an orchidometer (which consists of a string of graduated plastic beads on a string, and can be used to assess testicular volume by comparison).  A normal ultrasound can also be used to determine the size of the testes.

 

 

 
 
2. High-resolution colour-flow Doppler ultrasonography

doppler ultrasound

Doppler ultrasonography

High-resolution colour-flow Doppler ultrasonography is the method of choice to diagnose a varicocele and should be performed by a health care provider skilled at this task like a sonographer or radiologist.

This is a non-invasive method of diagnosing a varicocele so it is not painful. The ultrasound inducer is placed on the scrotum with some ultrasound lubricating gel.  So besides getting some gel smeared on him, the patient should not experience any pain with this diagnostic technique.

A colour Doppler ultrasound shows the direction of bloodflow in different colours on the screen.  The colour Doppler can demonstrate backflow in the veins which is diagnostic of a varicocele.  High resolution real-time scrotal ultrasonography defines a varicocele as a hollow tubular structure that grows when a Valsalva maneuver is done.
 
3. Venography

Venogram

Venogram

Retrograde venography can be used as a screening tool to detect or exclude varicocles. Venography is a diagnostic procedure in which x-rays of the veins are taken after a special dye is injected into veins. These x-rays are called venograms. The dye has to be injected constantly via a catheter which is usually inserted into a vein at the groin.

Venography is the most reliable method for detecting subclinical varicoceles (asymptomatic varicoceles) because the findings demonstrate abnormal retrograde blood flow into the spermatic veins or pampiniform plexus. It is also used when varicoceles reappear after surgical correction. However, the procedure is not the preferred means of diagnoses because it is invasive and exposes the patient to ionizing radiation.
 
4. Thermography

thermography

Thermography

Although not yet commonly used as a method of diagnosing a varicocele, studies have shown that thermography is a feasible and low cost method of diagnosing a varicocele.  It is also non-invasvie. Thermography measures temperature differences across the skin surface using a highly sensitive infrared camera. The amount of radiation energy emitted by an object increases with temperature; therefore, with thermography one is able to note variations in temperatures. Temperature measured at the pampiniform plexus which is higher than 34°C presents the main thermographic sign of a varicocele.  Thermography is still undergoing further testing and studies for its use in the diagnoses of varicoceles.
 
5. Radionuclide angiography

Radionuclide angiography

Radionuclide angiography

Radionuclide angiography is similar to venography and is also an invasive method of diagnosing varicoceles.  It is more accurate than a physical examination in detecting grade 1 varicoceles.  While venography is specifically associated with the investigation and imagine of veins, angiography is used to view both arteries and veins.  It is not commonly used to diagnose varicoceles.

 

 

 

 
6. CT Scans

CT Scans

CT Scan

This is used when a secondary cause of a varicocele is suspected like an intra-abdominal malignancy or kidney tumour.  It is not cost-effective or reasonable to order a CT scan on every patient presenting with a varicocele.  It is done if a secondary cause for the varicocele is suspected and/or the patient has other symptoms suggestive of a secondary cause.