Varicoceles: Treatment, surgery, and symptoms

Varicoceles are similar to varicose veins, but they occur around the testicles rather than the legs. They do not usually cause any serious problems, but they can impact male fertility.

They happen when certain veins in the scrotum become enlarged, due to a malfunction in some of the valves involved in pumping the blood. They affect around 15 percent of males,
and they tend to form between the ages of 15 and 25 years.

Varicoceles normally affect just one side, usually the left.

This article will look at the causes, symptoms and treatments of varicoceles.

Fast facts on varicoceles:

Varicoceles are similar to varicose veins but they affect the testicular area in men.

They are thought to affect 15 percent of men, usually between the age of 15 and 25 years.

The exact cause is unknown, but it may be similar to that of varicose veins.

They are not usually painful.

Varicoceles are not usually serious, but complications include fertility problems.

Surgery is possible, if complications arise.

What is a varicocele?

nurse holding model of male reproductive system
Varicoceles refer to enlarged veins in the testes.

A varicocele is an enlargement of the veins in the scrotum, the the bag that contains the testes. They are similar to varicose veins of the leg.

They affect a type of vein known as the pampiniform plexus.

The pampiniform plexus is found in the spermatic cord. This cord also holds the vas deferens, the tube that carries sperm, and the testicular artery, which transports blood to the testicles.

The creation of sperm is most efficient at around 34.5 degrees Celsius, or 94.1 degrees Fahrenheit, rather than the body’s standard 37 degrees Celsius. This is one reason why the testes are physically separate from the trunk of the body.

The main role of the pampiniform plexus is to cool the arterial blood before it reaches the sperm. It does this through a “heat exchange” mechanism.

Varicoceles can disrupt this cooling system. This can prevent the testicles from producing good quality sperm.

Treatment

Treatment is not usually necessary, unless there is:

pain and discomfort

a low sperm count

infertility that has continued for at least 2 years and is otherwise unexplained

In these cases, surgery may be recommended.

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Surgery

Three surgical options are possible:

Varicocelectomy: Open surgery is performed under local or general anesthetic. The surgeon will access the area through the groin, or less commonly, through the abdomen or upper thigh. Using ultrasound and surgical microscopes, they will close the affected veins to reroute the blood through other, healthier vessels. Post-surgical pain is normally minimal, and the individual can soon return to normal activities.

Laparoscopic surgery: The surgeon makes a small incision in the abdomen and passes a tiny surgical instrument through the opening.

Percutaneous embolization: A radiologist inserts a tube, or catheter, into the body through the neck or groin. Instruments are passed through the tube, and the surgeon uses coils or chemicals to block the vein by scarring it. This is a minimally invasive intervention. It can be done as an outpatient procedure, and recovery time is relatively short.

Risks of surgery

These procedures are relatively safe but, as with any surgery, there are some risks.

These include:

artery damage

further testicular atrophy

infection

bruising, swelling, or a buildup of fluids in the area

abdominal pain

Rarely, a renal vein thrombosis may develop. This can affect the kidney and may need further surgery.

Sometimes, the veins through which the blood passes after surgery also enlarge. Further treatment may then be necessary.

Symptoms

Varicoceles rarely cause pain, but if they do, the pain will probably:

be worse when standing or during physical exertion

vary from sharp to dull pain

decrease when lying on your back

worsen as the day goes on

Varicoceles will often go unnoticed, but a physician may notice them during a medical examination.

However, the individual should see a doctor if they notice:

any change in the size, shape, or appearance of the testes

a lump

fertility problems

swelling in the scrotum

veins that show as unusually large or twisted

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