What investigations are recommended to confirm the diagnosis of varicocele in primary care?

The provided UK guidelines do not explicitly recommend specific investigations to confirm the diagnosis of varicocele in primary care ¹. The diagnosis of varicocele, often described by grades (subclinical, Grade I, II, or III), appears to be based on clinical assessment ¹.

However, certain investigations or referrals are recommended in specific circumstances:

• Semen Analysis: If fertility is a concern for men with varicocele, semen analysis may be offered ¹. This is for assessing fertility, not for confirming the varicocele diagnosis itself ¹.
• Referral for Uncertainty: If there is uncertainty about the nature of a scrotal swelling, referral to a urologist is recommended ¹.
• Direct Access Ultrasound Scan: For unexplained or persistent testicular symptoms in men, a direct access ultrasound scan may be considered ⁵.