How is a varicocele diagnosed?
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A) Self Diagnosis
Many men know they have a varicocele because they can feel the mass of
dilated veins in the scrotum. This feels like a sac of worms or spaghetti.
These men have larger varicoceles. They may also notice: 1). The testicle is
smaller on that side. 2) They have discomfort in that testicle or side of
B) Physician's Diagnosis
During a physical examination a physician may diagnose a varicocele. It
can most clearly be felt when a man is standing and again, it will feel like
a bag of spaghetti. It may disappear when a man lies down (as the weight of
the blood and the veins is no longer pushing down past the malfunctioning
valves into the scrotum). In a standing position, the man may also be asked
to bear down (like he is having a bowel movement). The physician may feel an
impulse as the blood pushes backwards (because of the increased pressure
inside the abdomen) into the scrotum.
C) Sophisticated Testing
To confirm varicoceles, sophisticated tests are often used.
- A Doppler stethoscope will amplify the sound of blood moving past it.
When the patient pushes down, more blood flows backwards into the scrotum
and can be heard as a rushing sound.
- Ultrasound: The duplex ultrasound is currently considered the best
non-invasive way to identify or confirm the presence of varicoceles. The
duplex ultrasound has two parts. First a thorough ultrasound of the testis
is performed. The diameter of the veins can be measured. Other
abnormalities may be identified. A recent study found that 31% of men with
infertility had an abnormal finding on the ultrasound that was not
suspected by the physical examination.
The second part of the ultrasound evaluation measures the blood, which
flows past the probe when the patient pushes down. This blood flow
confirms the varicocele.
- A test which is rarely used anymore involves injecting a radioactive
substance into the blood stream. This can then be seen collecting in the
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