03.04 Varicocele

Hey guys! Today’s lesson is about varicoceles. By the end of the lesson, you will have a better understanding of what a varicocele is, assessment findings, diagnostic testing, treatment options, and nursing considerations when caring for these patients.
Okay guys, so a varicocele is an abnormal cluster of dilated veins behind and above the testis in the scrotum. One thing that can cause a varicocele is increased fluid due to damaged or incompetent valves in the testicular veins. They can occur unilaterally or bilaterally, but most are unilateral. Most also occur on the left side of the scrotum. So when you look at this picture here you can see on the left how the veins are thin and normal looking, and on the right it shows a varicocele. So the veins are dilated and engorged.

Okay guys, so the assessment findings for a varicocele are pretty straightforward and simple. When palpating the scrotum it will feel “wormlike” due to the dilated, palpable veins. Usually varicoceles are asymptomatic. They can be painful, but this is a rare finding. So this picture you can see the blue arrow is pointing to the left testis and it is larger than the right testis. If you look closely you can even see that the veins are dilated and visualized compared to the right side. So these dilated veins are what you would feel upon palpation.

Okay so first if the veins are able to be palpated, usually that is all that is needed for diagnosis. The veins are easier to palpate when the patient bears down, or performs the valsalva maneuver. This creates extra pressure in the veins causing them to be more prominent. If the veins are too small and are unable to be palpated, other diagnostic tests are used. One test is thermography which helps detect pockets of heat. The other method is a doppler, which helps magnify the sound of the blood flowing through the veins.

Ok, so moving on to therapeutic management. So most varicoceles are asymptomatic. If they are asymptomatic, no treatment is needed. If they are painful, they must be removed surgically. The surgery performed is called a Varicocelectomy, which is the surgical removal of a varicocele. One nursing consideration is that varicoceles can cause infertility from increased temperature due to the venous stasis near the testes. This can cause infertility because it alters the production of sperm. Surgical correction is indicated in these cases and can resolve the patient’s infertility. Our post-surgical care is centered around interventions that facilitate drainage and decrease swelling from the area because both of these interventions promote relief. Scrotal elevation helps with venous congestion and helps with drainage. Ice application is used for pain control and to help with swelling. Scrotal support is also used with ambulation to support the scrotum post-surgery. We want to be monitoring for increasing discomfort in the scrotum, as this could indicate infection, impaired circulation to testis, and testicular atrophy. Testicular atrophy is rare and occurs if the blood supply to the testis becomes insufficient.

There are a few patient education topics we need to be reviewing with our patients. First of all, if the patient’s scrotum becomes painful the provider needs to be notified, as surgical intervention will likely be the next step in treatment for the patient. If the patient has a varicocelectomy, we want to teach about interventions post operatively to help promote drainage and decrease scrotal swelling, such as scrotal elevation and icing. We need to educate about complications to watch for such as increasing discomfort in the testis, as this could indicate infection or impaired circulation.

Two of the nursing concepts in a patient with a varicocele include tissue and skin integrity impairment as the circulation in the testis is altered. Another nursing concept is alterations in reproduction, as varicoceles can cause infertility.
Ok guys so the key points I want you to remember include the assessment findings - so the scrotum will feel “wormlike” when palpating it due to the dilated veins. Normally patients are asymptomatic, but patients can have scrotal pain, however, this is rare. Diagnosis starts with palpation. If the veins are too small to palpate, thermography or doppler studies are used for further diagnosis. Most varicoceles are asymptomatic and don’t require treatment. However, if the scrotum is painful, a varicocelectomy is the next step in treatment. Post-op care includes interventions to facilitate drainage and help with swelling as well as monitoring for increased scrotal discomfort.
Okay guys, that is it for our lesson on varicoceles. Make sure to check out the resources attached to this lesson. Now, go out there and be your best self today, and as always, Happy Nursing!