- •Series Editor Foreword
- •Preface
- •Contents
- •Contributors
- •Differential Diagnosis
- •Evaluation
- •Treatment
- •Discussion
- •References
- •Background
- •Normal Pubertal Stages
- •Differential Diagnosis of Precocious Puberty
- •Evaluation [1, 3, 4]
- •Treatment [1, 2]
- •Discussion
- •References
- •Background
- •Differential Diagnosis of Delayed Puberty
- •Evaluation
- •History and Physical Examination
- •Laboratory Investigation and Imaging
- •Treatment
- •Discussion
- •Suggested Readings
- •Discussion
- •Differential Diagnosis
- •References
- •Discussion
- •References
- •Differential Diagnosis
- •Evaluation
- •Treatment
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •Interpretation of Thyroid Function Tests (TFTs)
- •Iodine Supplementation for Pregnancy and Lactation
- •Screening for Maternal Hypothyroidism
- •Maternal Subclinical Hypothyroidism
- •Thyroid Autoimmunity
- •Maternal Hyperthyroidism: Diagnosis
- •Maternal Hyperthyroidism: Treatment
- •Postpartum Thyroiditis
- •Summary
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •Intrauterine Pathology
- •Thin Lining
- •Endometrial Receptivity Analysis (ERA)
- •Chronic Endometritis
- •Conclusion
- •References
- •Discussion
- •References
- •Discussion
- •History
- •Physical Exam
- •Semen Analysis
- •Laboratory Testing
- •Genetic Testing
- •Adjunctive Tests
- •Imaging
- •References
- •Discussion
- •Pathophysiology
- •Evaluation
- •Treatment
- •Lifestyle Changes
- •Medications
- •Phosphodiesterase 5 Inhibitors
- •Vacuum Erection Device
- •Intraurethral Alprostadil
- •Intracavernosal Injections
- •Surgery
- •References
- •Discussion
- •History
- •Semen Analysis
- •Physical Examination
- •Proper Varicocele Examination
- •Laboratory Investigations
- •Additional Investigations for the Pain Include
- •Other Investigations for Infertility in the Context of Varicoceles
- •Treatment
- •Indications for Varicocele Treatment Include the Following
- •Numerous Treatments for Varicocele Exist
- •References
- •Discussion
- •Semen Analysis
- •History and Physical Examination
- •Laboratory Investigations
- •Testicular Biopsy
- •Treatment
- •Surgical Techniques for Sperm Retrieval [13]
- •Fresh Vs. Frozen Sperm
- •Counseling
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Background
- •Epidemiology
- •Evaluation
- •Treatment
- •Non-ART Treatment
- •Accelerated Utilization of ART
- •ART Success Rates
- •Recent Trends in ART
- •Discussion
- •Conclusion
- •Suggested Readings
- •Evaluation
- •Differential Diagnosis
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •Suggested Readings
- •Diagnosis
- •Management
- •Discussion
- •References
- •Index
25 Varicocele |
169 |
Laboratory Investigations
In a patient with signs and symptoms of hypogonadism as well as infertility, a baseline testosterone is warranted. Serum measurement (normal range 270–1070 ng/ dL), preferably obtained in the morning due to the natural diurnal variation, provides an assessment of testicular function and/or failure.
The addition of follicle-stimulating hormone (FSH) is useful in men with sperm concentration <10 million/mL, altered sexual function or clinical signs of an endocrinopathy according to the AUA guidelines [3]. An elevated serum FSH (normal <8 IU/mL) is indicative of impaired sperm production as opposed to obstruction. Other hormones may be ordered based on clinical indication or at the discretion of the provider including luteinizing hormone (LH), thyroid stimulating hormone (TSH), estradiol and prolactin.
Additional Investigations for the Pain Include
•\ Scrotal ultrasound: for varicocele assessment, presence of scrotal mass, hydrocele or spermatocele. Numerous grading schemes exist, but generally veins >3 mm are considered clinically signi cant [5]. The Sarteschi classi cation includes the following [6]:
––Grade 1—Venous refux at the emergence of the scrotal vein only during the Valsalva maneuver; hypertrophy of the venous wall without stasis.
––Grade 2—Supratesticular refux only during the Valsalva maneuver; venous stasis without varicosities.
––Grade 3—Peritesticular refux during the Valsalva maneuver; over varicocele with early-stage varices of the cremasteric vein.
––Grade 4—Spontaneous basal refux that increases during the Valsalva maneuver, possible testicular hypotrophy, overt varicocele, and varicosities in the pampiniform plexus.
––Grade 5—Spontaneous basal refux that does not increase during the Valsalva maneuver, testicular hypotrophy, overt varicocele, and varicosities in the pampiniform plexus.
•\ Semen culture after antibacterial skin prep for gonorrhea, chlamydia, and ureaplasma if there is a suspected infectious etiology contributing to the pain. Urine culture and sensitivities should be ordered only if urinary symptoms are present.
•\ Abdominal imaging: For patients with an isolated right sided varicocele, especially ones that do not collapse when supine, further imaging of the abdomen to rule out a renal tumor or other retroperitoneal process.
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