Varicocele

• Grade 1 palpable only with Valsalva; grade 2 palpable without Valsalva; grade 3 visible. Examine standing and supine.

• Differentials: hydrocele (transilluminates), inguinal hernia (cough impulse), torsion (acute severe pain), spermatocele.

• Investigations: scrotal Doppler (veins over 2.5 mm with reflux); semen analysis.

Management

• Scrotal support; analgesia – adults paracetamol 0.5–1 g every 6–8 hours or ibuprofen 400 mg every 8 hours; children paracetamol 10–15 mg/kg every 6 hours or ibuprofen 5–10 mg/kg every 6–8 hours.

• Varicocelectomy for palpable varicocele with abnormal semen, testicular atrophy or chronic pain (inguinal or sub-inguinal ligation at regional level; microsurgical at referral hospitals).

• After surgery: semen analysis every 3 months for 1 year; watch for hydrocele or recurrence.