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varicocele is made primarily by physical examination, and the duplex ultrasound should be used only to corroborate or confirm results of the physical examination. There are currently no standard and clearly defined criteria for diagnosing a varicocele by ultrasound, however.


What are the treatment options for varicoceles? Treatment of varicoceles is an appropriate consideration in some patients with infertility, pain or testicular atrophy. No medical therapies are available for either treatment or prevention; however analgesic agents may alleviate associated pain when present.


There are two main approaches to the treatment of a varicocele: SURGICAL REPAIR: This approach involves a variety of specific techniques, but all involve ligation (or blocking) the veins to the testicles thus interrupting blood flow in the vessels of the pampiniform plexus. The surgical


approaches include open surgical repairs performed through a small single incision with or without the use of a operating microscope. Laparoscopic varicocele repair which utilizes telescopes passed through the abdominal wall are not generally used since they are thought by most to have greater potential for serious complications than standard surgical techniques without significant advantage. The open procedures are performed under a variety of anesthetics, from local to general anesthesia, whereas the laparoscopic approach is uniformly performed under a general anesthetic agent. With the advent of smaller incisions, which avoid muscle transection, the open procedures are becoming closer to the laparoscopic techniques in both speed of recovery and postoperative pain with virtually no risks of serious complications. Complications are uncommon, but include varicocele persistence/recurrence, hydrocele formation and injury to the testicular artery. The rates of these complications are highly contingent upon the surgical approach and a surgeon’s skills. The


THE RESOURCES LISTED IN THIS DIRECTORY ARE UNSCREENED AND SHOULD NOT BE VIEWED AS RECOMMENDATIONS OR ENDORSEMENTS, EITHER EXPRESS OR IMPLIED, BY THE AFA. 57


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