Which of the following conditions is this man most likely to have

Answer the question
A 23-year-old healthy man has been unable to father a child. He and his wife have a workup for infertility. His wife’s reproductive function is normal. On physical examination both his testes are palpable in the scrotum and the testes and scrotum are normal in size, with no masses palpable. However, the spermatic cord on the left has the feel of a ‘bag of worms’. Laboratory studies show oligospermia. Which of the following conditions is this man most likely to have? Explain your answer.
A Hydrocele
B Testicular torsion
C Spermatocele
D Varicocele
E Seminoma
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Formatted and cited in current APA 7
Use 2 academic sources. Not older than 5 years
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**ANSWER**
Based on the clinical presentation described, the most likely condition this man has is D. Varicocele.
Varicocele is a common cause of male infertility and is characterized by the dilation of the pampiniform plexus of veins within the scrotum, often described as feeling like a “bag of worms” when palpated. Varicoceles can lead to impaired testicular function, which may result in oligospermia (low sperm count). In this case, the presence of a varicocele on the left side is particularly suggestive, as the dilated veins can impede blood flow and raise the temperature in the scrotum, which can negatively impact sperm production and quality. The right testis may still be functional, as the left varicocele might not affect it.
The other options can be ruled out for the following reasons:
A. Hydrocele: Hydrocele is the accumulation of fluid in the scrotum, resulting in scrotal enlargement. It does not typically cause infertility.
B. Testicular torsion: Testicular torsion is a medical emergency where the spermatic cord twists, leading to a sudden onset of severe testicular pain. It is not associated with infertility or oligospermia.
C. Spermatocele: A spermatocele is a benign cyst containing sperm that forms in the epididymis and is usually painless. While it might be associated with a palpable mass, it is not typically linked to infertility.
E. Seminoma: Seminoma is a type of testicular cancer. While it can lead to testicular enlargement and potentially impact fertility if left untreated, it does not cause a varicocele-like “bag of worms” sensation in the scrotum and is not primarily associated with male infertility.
Therefore, the most likely condition in this case is a left varicocele, which is a treatable cause of male infertility. The patient may benefit from evaluation by a urologist to discuss potential treatment options, such as surgical repair of the varicocele to improve fertility. It is important to address this issue promptly if the couple desires to conceive. References:
1. Nieschlag E, Behre HM, Nieschlag S. Andrology: Male Reproductive Health and Dysfunction. Springer, 2010.
2. Tanrikut C, Goldstein M, Rosoff JS, Lee RK, Nelson CJ, Mulhall JP. Varicocele as a risk factor for androgen deficiency and effect of repair. BJU Int. 2011;108(9):1480-1484.