In order for the clinician to diagnose a varicocele, the patient needs to:
A. Lie in the left lateral recumbent position
B. Stand and bear down
C. Lean over for digital rectal exam
D. Lie in the supine position
ANS: B
Most varicoceles are asymptomatic, but the patient may complain of a dull ache, fullness, pain that does not radiate, or pulling to the affected side of the scrotum. If the varicocele is large enough, it typically results in scrotal swelling that is noticeable to the patient, along with a bluish discoloration beneath the scrotal skin. Primary or secondary male infertility may be the presenting symptom. The varicocele can be exaggerated during physical examination by asking the patient to perform the Valsalva maneuver while standing; any distention of the pampiniform plexus should disappear when the patient lies down.
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