Varicocele
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What is a Varicocele?

A varicocele is dilated veins surrounding the testicle. They are most commonly found on the left but can be seen on both sides. They are often described as a “bag of worms” around the testicle. Some varicoceles are large and can be seen protruding underneath the scrotal skin. Others are small and only noticeable on exam.

Can Varicoceles Cause Problems?

Approximately 15% of men have a varicocele. Thankfully the vast majority do not create problems. Unfortunately, some varicoceles can cause pain in the testicle and infertility.

How Do Varicoceles Cause Problems in the Testicle?

The testicles optimally produce testosterone and sperm at a temperature that is slightly lower than our internal body temperature (98.6 degrees Fahrenheit). The purpose of the scrotum is for the testicles to reside outside of the body where the temperature is cooler. Varicoceles are dilated veins that can increase the pooling of warm blood around the testicle which can raise the scrotal temperature. This can impair sperm production or cause pain.

 

Pain in testicle, cause by a varicocele, is typically characterized as a dull throbbing pain that gets worse with prolonged standing and improves when lying down.

Who Should be Evaluated for a Varicocele?

Men having pain in the testicle or fertility concerns should see a urologist to determine if they have a varicocele.

How Will I be Evaluated for a Varicocele?

A urologist will first take a history from you to determine the extent of fertility or pain concerns. They will also need to examine the scrotum. This will help them identify the presence and severity. They are graded on a scale of 1-3 with 3 being the most severe. The urologist also may want to get a scrotal US to supplement their examine.

Many times, the urologist may also want to check testosterone and fertility hormones. This is just a blood drawn. This is important because varicoceles can also cause low testosterone.

Lastly, if there are any fertility concerns, they will likely set up semen testing prior to discussing any surgical repairs

Who Needs to Have the Varicocele Repaired?

Men with pain refractory to conservative management. Typically, urologist will advise anti-inflammatories and supportive briefs. When this alone is not enough, it is reasonable to consider repair.

Men with abnormal semen testing will also want to consider repair. Approximately 70% of men will see improvement in semen testing after repair.

How is a Varicocele Repaired?

Most varicoceles are repaired surgically. This is typically done through a small incision in the groin or laparoscopically. Varicocele recurrence rates are lowest when they are repaired with surgical microscope. In this instance, the veins are tied off with permanent stitches to help re-route the blood flow to and from the testicle. After repair, the blood will come in through the artery and then leave quickly through the small testicular veins. This results in less congestion of the testicle. It is important to remember that this is not a vein stripping procedure. They varicocele veins will always be present, but they will be small and non-functional.

What Do I Need to Know About the Surgery?

It is an outpatient procedure, covered by insurance, and takes approximately 30 minutes per side. General anesthesia will be needed. There will typically be a small incision in the groin if it was repaired using a microscope.

Most men will want to take at least 48-72 hours off work and need to wear supportive briefs for approx. 2 weeks. The stitches are absorbable. It is fine to shower. The varicocele will start swelling approx. 24-48 hours after surgery and then will gradually dissipate in size over the next two weeks. Most men will not need narcotic pain medication. Anti-inflammatories and icing are usually more than sufficient.

How Long Before I Will See Improvement in My Fertility?

Approximately 70% of men will see improvement in their semen testing, but this can take some time. A sperm cell cycle is 72 days, so semen testing is typically not repeated after repair for at least 3 months. Average time that it takes for men to see improvement is approximately 6-9 months.

What are the Risks of Surgery?

Varicocele surgery is generally a very safe procedure. In rare circumstances, a patient could have pain, a blood collection around the testicle, recurrence, or infection.

It is normal to have mild pain, swelling and bruising. This typically dissipates very quickly.

Additional Resources:

Schedule An Appointment

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