Classification of varicocele:
(1) primary, or idiopathic
(2) secondary, due to compression of the internal spermatic vein by tumor or other cause
Patient examination:
(1) The patient is examined while standing. This increases the venous pressure.
(2) If the plexus is not visibly or palpably present, then the patient is examined following a Valsalva maneuver, which increases the intra-abdominal pressure.
(3) For borderline or complex cases, Doppler ultrasound may be used to demonstrate the distension of the plexus.
(4) If a palpable lesion is present, it may be noted to be firm when the patient is standing and less so when the patient is lying down (when the venous pressure is less).
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Clinical Findings
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Grade
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enlargement of the pampiniform plexus, but only palpable following a Valsalva maneuver
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I
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palpable enlargement of the pampiniform plexus without performing the Valsalva maneuver
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II
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visible enlargement of the pampiniform plexus
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III
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Physical examination may be limited in the presence of:
(1) scar tissue from previous surgery
(2) hydrocele
(3) maldescended testes
