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Right side varicocele
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Right side varicocele


  I have been experiencing testicular pain (right side) for about 9 months.
  Over the past 4 months, a rather large lump has appeared on the top of the right testicle.
  The lump started out small, but is now about the size of a grape.  It is present all
  of the time, but is less pronounced when lying down.
  The pain ranges from a dull ache to a very excruciating jolt of pain and is
  present to some degree almost all of the time.  At times, pain can also be felt in the
  groin area, right inner thigh and abdomen (lower, bladder area to above the navel).
  I first saw a Urologist in March (when the lump became visibly noticeable and the pain more
  constant).  He ruled out epididimytis and suggested the onset of testicular torsion and sent me
  on my way.  Since then, the pain has worsened and the lump grown.  I saw my primary care physician
  last Friday (a new Doctor; my first visit).  He examined the testicle and noted the lump.  He ruled
  out epiditimytis and torsion.  He ordered blood work (AFP and HCG), chest x-ray and an ultrasound.
  The blood work came back negative and the x-ray was clean.  The ultrasound revealed, according to
  the radialogist, a large varicocele.  According to everything that I have read on the net, a
  varicocele is usually accompanied by discharge and painful urination.  I have neither of these
  symptoms.  The lump is on top of the testicle and is it is very difficult to differentiate the lump
  from the testicle.  Also, near the bottom front of the same testicle, I have just found a small lump.
  It feels slightly linear and may be part of the epididymis.  The only concern I have about this lump
  is that it's on the bottom front of the testicle.  I do not know if the epididymis can also be present
  in that area of the testicle.  I was not aware of this lump at the time of the ultrasound, so I did not
  mention it.  The tech. did not find it on her own.  It might be about 1/4 inch long and 1/8 inch wide and
  is very hard.  I have asked my primary care physician for a referral to a Urologist to confirm the
  varicocele.  One area of interest, I have a history of clotting (I'm 34 and have had deep vein thrombosis
  in the right leg, and two central retinal vein occlusions in the right eye).  Because of this, my doctor
  wants to talk with a Hematologist prior to sending me to a Urologist.  I don't want to wait.
  Could a right sided varicocele be presented directly on top of the testicle and could a history of clotting
  be related to the formation of a varicocele.  I was recently on coumadin and prednisone for the CRVO and
  they had no effect on the lump.  I'm not overly concerned about TC at this time, however it does cross my
  mind.  I'm not convinced that it's a varicocele.  It just does not feel or present to me the way it's defined
  on the web sites I've read.  I would like your thoughts so that should I really need to push my doctor to get
  me to a Urologist quickly, I will do so.  I have read too many stories, and heard from too many people,
  of TC being misdiagnosed as varicoceles.
  Also, do all bothersome (painful) varicoceles require surgical repair, or can they resolve on their own?
  I look forward to your reply and thanks in advance.
--------------------------------------------------------------------------------------------------------------------------------
Dear Mark,
Varicoceles are a common problem. They result from dilation of the veins that supply the testicle and scrotum . Most commonly varicoceles occur on the left. This is due to the drainage of the left testicular vein into the left renal vein. In contrast, right -sided varicoceles occur less frequently due the right testicular vein draining directly into the inferior vena cava ( the largest vein in the body). The complications of varicoceles include pain, abnormal appearance of the scrotum and reduced fertility. Removal of varicoceles surgically can be performed by a variety  of approaches. The incision can be made in the lower quadrant or in the scrotum. Recovery time is 2 to 4 weeks.
Your case is unusual in that you have the propensity to form blood clots. This may indeed be the cause of your right-sided varicocele. However, whenever a patient has a varicocele on the right one must be concerned about a pelvic or abdominal cancer compressing the veins that are causing the varicocele. Therefore in addition to a hematologist I would recommend your urologist perform an abdominal ultrasound or CAT scan to rule out malignancy. This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
HFHS MD-KR
*keyword: varicocele

  




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