Varicocele
What Is a Varicocele?
A varicocele is a condition in which veins in the scrotum, which is the sac holding the testes, become dilated and enlarged. Varicoceles are very common, occurring in about 15% of the general male population and 40% of men with infertility. Varicoceles tend to appear during puberty or adulthood. The cause of the condition is not well understood, but it is likely due to the anatomy of how these veins drain blood from the testicles back to the heart. Problems with valves within the veins or two much pressure above the veins can cause enlargement. Varicoceles are more common on the left due to how the blood drains into the left renal vein on that side.
A varicocele is merely an anatomical finding, which often has no medical impact or significance. In some cases, varicoceles can cause pain in the scrotum, reduced size of the testicle, low testosterone production, and/or infertility. In less than 50% of cases, varicoceles can lead to abnormal semen parameters. A leading theory is that the pooling of blood caused by dilated veins raises the temperature inside the scrotum, and the elevated temperature damages sperm.
A varicocele can be diagnosed with a physical examination of the scrotum/testicles or a scrotal ultrasound. Varicoceles are graded on a scale from 1 to 3, depending on the size.
Treatment for varicocele should be considered for men with pain in the scrotum and/or infertility and an abnormal semen analysis. Varicoceles are treated with an outpatient surgical procedure under general anesthesia. The surgery takes approximately 30-45 minutes per side. In a varicocelectomy, a small groin incision is made and a surgical microscope is used to identify the dilated veins within the spermatic cord, a structure which carries blood vessels, nerves, and the vas deferens to the testicles. The dilated veins are tied off and cut.
Serious complications of varicocele repair are rare. Risks include pain/swelling, bleeding, infection, injury to the testicles, and the risks of general anesthesia. Persistence or recurrence of varicocele after surgery occurs in about 10% of patients. Following surgery, a majority of men will see an improvement in their semen parameters in about 3 months.
Most men will take 1-2 days off work and experience mild pain/discomfort at the incisions and in the scrotum for 1-2 weeks. The pain can usually be managed with ice packs and over-the-counter medications. Patients are asked to refrain from heavy lifting, exercise, and sexual activity for 1-2 weeks.