Abstract
A varicocele is an abnormal dilatation and tortuosity of the veins of the spermatic
cord. Although varicoceles are common in the general population and are frequently
found on routine physical examinations, they represent the most common correctable
cause of male factor infertility. Varicoceles are also often incidental findings on
imaging studies, particularly scrotal ultrasound. Importantly, not all varicoceles
should be treated equally (or at all), and basic guidelines on the evaluation and
indications for treatment of adult varicoceles should be reviewed before counseling
and treatment. A semen analysis should be obtained for any male patient of reproductive
age considering intervention. The adolescent varicocele is managed much differently
than the adult varicocele and remains a source of controversy. This review describes
the clinical presentation and the evaluation of adult and pediatric varicoceles, and
provides guidance on their diagnosis and workup. It also describes options for surgical
repair and the success and complication rates associated with each surgical approach,
ultimately supporting microsurgical subinguinal varicocele repair as the current surgical
standard.
Keywords
varicocele - varicocelectomy - infertility - interventional radiology
