Varicocele affects men of any age.
A varicocele involves an enlargement of the veins within the scrotum, the sack of skin that holds the testicles. It is often compared to a varicose vein of the leg and resembles a bag of worms. A varicocele can be painful and may negatively affect testosterone production and fertility due to diminished sperm count and quality.
- It affects 15 percent of men, more commonly in the left testicle.
- It is more commonly diagnosed among men with fertility issues.
The cause is not well understood, but is likely due to blood flow issues in the spermatic cord that delivers blood to the testicles. The valves in these veins, located within the scrotum just above the testicles, are thought to be defective, causing blood to back up and the veins to dilate. This usually occurs during puberty when the testicles are growing and require extra blood flow. The diminished circulation causes the temperature within the testes to rise, which can damage or block sperm.
Symptoms can include a feeling of heaviness or pain ranging from a dull to sharp ache in the testicle. The enlarged veins, and one smaller testicle, may be visible. These symptoms tend to worsen as the day progresses or after standing for long periods and are relieved by lying down. Symptoms are not always present, and this issue is often discovered during a routine check-up or in a fertility evaluation.
Fortunately, this issue is relatively easy to diagnose. A more pronounced varicocele can be encountered during a routine physical exam. A less prominent varicocele will require further testing, including an ultrasound, which can detect the sound of backflow in the veins.
Treatment is worth considering if you are experiencing pain, fertility issues, or significant testicular atrophy, or if you are concerned about future fertility and testosterone production.
Surgery to tie off the damaged vein and redirect blood flow is an option. It is an outpatient process that can be done laparoscopically or preferably as open surgery. Surgery is done using a high-powered microscope allowing for precise access to the affected veins. The surgeon will usually access the spermatic cord through the groin (inguinally or subinguinally) or abdomen. All veins will be ligated while arteries, lymphatics and the vas deferens are preserved.
Minimal pain is experienced during recovery. Your doctor may prescribe pain medication. Recovery usually requires a few weeks, although you can return to gentle activities within a couple of days.
Percutaneous embolization offers a nonsurgical option for treatment. This involves the insertion of a catheter through a vein in the groin or neck to reach the varicocele. The blood flow in the involved testicular veins is blocked with a balloon, coil, or solution.