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Diseases & Conditions

Varicocele

A varicocele is a disorder in which the veins coming from the testicle are dilated, or widened, because of a problem with the valves that control the flow of blood from the testicles to the body. As a result, blood tends to pool in the veins in the spermatic cord, the cord that runs from the testicle into the body.

Varicocele is a fairly common condition; it affects nearly 1 in 5 men in the United States. Most varicoceles are noticed when a man is a teenager, but varicoceles can happen at any time in a man’s life. Because of the structure of a man’s anatomy, varicoceles are more common in the left side, but can occur in either, or both, spermatic cords.

What are the symptoms of varicocele?

Most men with a varicocele will not have symptoms. Some men, however, may feel a dull discomfort in the affected testicle, especially after exercising, standing for a long time, or at the end of the day. The discomfort will usually improve when the man lies down.

The testicle on the same side as the varicocele may be smaller than expected. If the varicocele is repaired in childhood or adolescence, the testicle may grow to “catch up” in size. Testicle size does not increase when the varicocele is repaired in adults.

What problems are caused by varicocele?

The main problems caused by a varicocele are that it may cause pain and it may affect a man’s fertility, or his ability to have children. These are the most common reasons a man chooses to have the varicocele treated. Not all pain in the genital area is caused by a varicocele. If you are having pain, please discuss your symptoms with your health care provider.

How is varicocele diagnosed?

The doctor can diagnose a varicocele during a physical examination by palpating, or feeling, the spermatic cord. A varicocele is described as feeling like a bag of worms in the scrotal sac. As mentioned, the testicle with the varicocele may be smaller than the other testicle.

In some cases, the doctor may perform an ultrasound to confirm the diagnosis. Ultrasound, also known as sonography, or ultrasonography, is a procedure that transmits high-frequency sound waves through body tissues. The echoes are recorded and transformed into video or photographs of the inside of the body.

Semen tests and blood tests may be recommended in men with a varicocele who are concerned about their fertility.

How is varicocele treated?

The decision to treat a varicocele depends on whether you are having symptoms and on whether you are trying to have children. Men who are not having symptoms usually do not need to be treated. For men who are having mild or occasional symptoms, the following steps may be enough to control the discomfort:

  • wearing a jockstrap during exercise or prolonged standing;
  • avoiding activity that causes the discomfort;
  • applying ice to the scrotum and groin, and/or;
  • taking the occasional over-the-counter pain reliever such as ibuprofen or acetaminophen.

If these non-invasive measures do not help relieve the varicocele symptoms, or if the man is worried about fertility, the varicocele can be treated with surgery or a procedure called an embolization. The goal of these treatments is to stop the flow of blood through the enlarged veins.

During embolization, the varicocele veins are intentionally blocked from inside the vein by causing a clot in the veins. During surgery, the varicocele veins are intentionally blocked by applying a clip or tie to the outside of the veins. Both treatments are outpatient procedures, which means that you will go home the same day as the surgery or embolization.

Recovery after surgery

A responsible adult will need to drive you home and stay with you the first night after surgery.

You should spend most of the day of surgery and the first day after lying down or reclining at home. You should walk gently around the house to exercise your calf muscles, to use the bathroom, and to eat.

When you are reclining or lying down, exercise both calf muscles every hour. Walking and exercising your calf muscles will help prevent the formation of blood clots in the leg veins.

Some discomfort and pain are expected after surgery. However, most patients report only mild to moderate pain--typically, 5 or less on a pain scale of 0 to 10) after this operation. There are many things you can do to manage your postoperative pain and make your recovery more comfortable:

  • Speak to your physician about using over-the-counter nonsteroidal anti-inflammatories (also called NSAIDs) such as ibuprofen. NSAIDs will make a prescription pain reliever, should you need to take one, more effective.
  • Apply an ice pack to the scrotum and area of the incision for 20 minutes of each hour that you are awake. Ice packs are particularly helpful the first few days after surgery.
  • Elevate the scrotum on a small towel or pillow while you are sitting or lying down to help relieve discomfort and minimize swelling. This is especially helpful the first few days after surgery. The scrotum is elevated enough if the testicles are at the same level as the front of the thighs.
  • Wear a scrotal support (a jock strap) in the first few weeks after surgery to help minimize discomfort while you are standing, walking, or exercising.
  • Patients are usually given a prescription for a narcotic pain reliever. In general, you should use the prescription pain reliever when your pain level is greater than a 5 on a 0 to 10 scale.

You will have steri-strips and a gauze dressing covering the incision. Two days after surgery, you can remove the dressing (but not the steri-strips) and take a shower. Leave the steri-strips in place until they fall off, which will be one to two weeks after the surgery.

Other tips include the following:

  • Do not take baths, go swimming, or otherwise get the incision wet until the steri-strips have fallen off and the wound has healed, which should take about two weeks.
  • Do not do any heavy lifting after your surgery. For at least a week, you should also avoid any physical exertion or standing for any extended period of time.
  • After one week, you can exercise again. Don’t go “all out” with exercise for another two weeks.
  • You should be able to return to work in three days.
  • After one to two weeks, you should be able to resume sexual activity.

Results of surgery

  • Surgery for painful varicocele: most patients with pain from a varicocele will have a major improvement in pain, or even complete pain relief.
  • Surgery for fertility: Several studies demonstrate that sperm numbers and motility improve after varicocele surgery. Some studies suggest that couples who have the varicocele fixed are 30 to 50% more likely to get pregnant that couples that do not have their varicocele fixed.

Side effects of surgery

Some of the potential side effects of outpatient surgery include the following:

  • Blood clots in the legs, also known as deep venous thrombosis (DVT). A DVT can travel to the lungs, which is known as a pulmonary embolus (PE). DVT is reported in less than 5% of patients, and PE is reported in less than 1%.
  • Infection at the site of the surgery. This is reported by less than 1% of patients.
  • Shrinking of the testicle on the side of the surgery. This is reported in less than 1% of patients.
  • Constant buildup of fluid around the testicle, also known as a hydrocele. This is reported in less than 1% patients.
  • Return of the varicocele. This is reported by less than 5% of patients.
  • Failure to relieve pain. Up to 15% of patients will have no relief, or inadequate relief, of pain after a subinguinal varicocelectomy.
  • Onset of pain. In rare cases (less than 1%), patients who do not have pain will develop pain at a surgical site.
  • Continued infertility. While some couples do get pregnant more readily after varicocele surgery, not all couples will benefit from surgery.

Call your doctor if you have any of these side effects.

References:

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/26/2013…#15239