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What is a Varicocele?

A varicocele is enlarged veins in the scrotum, the loose pouch of skin that contains the testicles. This is a surgically correctable condition. Similar to varicose veins in the legs, varicoceles are caused when valves controlling blood flow along the testicular cord fail to operate normally, causing a backflow of blood and swollen veins. This causes elevated temperatures that are thought to interfere with normal sperm production and inhibit the production of testosterone.

Affecting about 20% of men aged 15 to 25 years, varicoceles usually develop above the left testicle and occasionally in both testicles.

Symptoms of a Varicocele

Most men with varicoceles often have no symptoms and most varicoceles go unnoticed until a physical exam or a fertility workup. Symptoms may include:

  • Aching or feeling of heaviness in the testicle, especially after standing for a long time
  • Atrophy (shrinkage) of the testicle
  • Visible or palpable enlarged veins that may look like “a bag of worms”
  • Infertility
  • A mass in the scrotum

Diagnosis

In most cases, your doctor can detect the varicocele through a physical exam. He may ask you to take a deep breath and bear down (called the Valsalva maneuver) to improve detection. If the exam is not conclusive, he may order an ultrasound of the testicles to provide a painless view of their internal structures.


Varicoceles and Male Infertility

Varicoceles are a common cause of male infertility and the most common cause of sperm production problems that can lead to male infertility. Some 40% of infertile men have a varicocele and about 80% of those who have already fathered a child but are now infertile, have one. Doctors suspect that varicoceles can cause infertility in some men by raising the temperature in the testes, which may damage or destroy sperm.


Varicocele Repair

Most varicoceles do not require treatment. If you experience pain or atrophy of the testicle or if you are infertile, you may wish to undergo one of several treatments:

  • Microsurgical varicocelectomy is usually considered to be the best treatment for relieving pain caused by the varicocele, and also to improve semen parameters, testicular function, and pregnancy rates in couples with male factor infertility associated with varicocele. A microsurgical varicocelectomy is performed on an outpatient basis under general anesthesia. A small incision (2cm) is made just above the pubic bone. The veins are then isolated and tied off so that the varicose veins are permanently closed and blood flow is redirected to the unaffected veins.
  • Laparoscopy is performed less often because it can present more risks. Laparoscopy may have the advantage of identifying veins higher up, where your surgeon likely will need to tie off fewer veins. The urologist makes several tiny incisions in your abdomen, using tiny instruments under general anesthesia to repair the varicocele.
  • Percutaneous embolization is usually performed when other approaches have failed. A radiologist passes a tube through a vein in the groin to the affected area and releases a coil or balloon to block off the affected vein.

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