A varicocele is an abnormal dilatation and tortuosity of the veins of the spermatic cord. Although varicoceles are common in the general population and are frequently found on routine physical examinations, they represent the most common correctable cause of male factor infertility. Varicoceles are also often incidental findings on imaging studies, particularly scrotal ultrasound. Importantly, not all varicoceles should be treated equally (or at all), and basic guidelines on the evaluation and indications for treatment of adult varicoceles should be reviewed before counseling and treatment. A semen analysis should be obtained for any male patient of reproductive age considering intervention. The adolescent varicocele is managed much differently than the adult varicocele and remains a source of controversy. This review describes the clinical presentation and the evaluation of adult and pediatric varicoceles, and provides guidance on their diagnosis and workup. It also describes options for surgical repair and the success and complication rates associated with each surgical approach, ultimately supporting microsurgical subinguinal varicocele repair as the current surgical standard.

New anticoagulant and antiplatelet medications have been approved and are prescribed with increased frequency. Intracranial hemorrhage is associated with the use of these medications. Therefore, neurosurgeons need to be aware of these new medications, how they are different from their predecessors, and the strategies for the urgent reversal of their effects. Utilization of intraluminal stents by endovascular neurosurgeons has resulted in the need to have a thorough understanding of antiplatelet agents. Increased use of dabigatran, rivaroxaban, and apixaban as oral anticoagulants for the treatment of atrial fibrillation and acute deep venous thrombosis has increased despite the lack of known antidotes to these medications.

R enal and urologic manifestations of inflammatory bowel disease (IBD) are not uncommon. 5-Aminosalicylates (5-ASA) such as mesalazine are used in the treatment of mild to moderate Crohn disease. Their use has been reported as a cause of allergic acute interstitial nephritis (AIN), with 9 documented cases of pediatric mesalazine-induced interstitial nephritis. The average time from mesalazine initiation to signs of renal injury in these cases was between 4 and 48 months (1).Tubulointerstitial involvement by direct extension of Crohn disease is a rare extraintestinal manifestation. Classically, these patients presented with nonspecific signs, such as fever, fatigue, abdominal pain, nausea, vomiting, and diarrhea. Ultrasound can be

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