Varicocele

Definition

This is an enlargement of the veins of the spermatic cord, commonly occurring on the left side in adolescent males.

Description

Varicocele forms a soft, elastic swelling that can cause pain. It is most common in men between 15 and 25 years of age and affects the left spermatic cord more often than the right. Varicocele is most pronounced and painful in the standing position.

Although varicoceles are common and generally benign, they are also a frequent cause of correctable male infertility. What the condition does to sperm production is not entirely clear, but it may affect the testicle by increasing its temperature. Approximately 20 percent of fertile men have a varicocele, but twice as many infertile men have them.

Varicocele is on the left side in 90 percent of cases, presumably because of venous drainage of the left testes to the left renal vein, causing increased retrograde pressure. Mild varicoceles are commonly asymptomatic, but a dragging scrotal sensation may be felt.

Varicoceles are sometimes confused with the most common scrotal mass, the hydrocele - an over-accumulation of the fluid that is normally found between the two layers of membrane that envelop the testicle. The excess may result from an overproduction or under-absorption of the fluid. Occasionally, the hydrocele is the result of an injury. Like cysts, hydroceles rarely require treatment.

Causes and Risk Factors

A varicocele consists of abnormally distended veins, like varicose veins in the legs, except in this case leading from the testicle. Generally, these veins are a "one-way street," allowing the blood to drain from the testicle, but not to return. With a varicocele, the blood returns to the testicle, causing alterations in sperm production.

Diagnosis

Varicoceles are usually confirmed on physical examination by a physician. Varicoceles should diminish in size or disappear with the patient in the supine position (lying face upward).

A tumor of the testis may be suspected if a painless, firm, solid lesion is found within the substance of the testis.

Treatment

If the varicocele is large or unsightly, it can be removed surgically. The more common reason for surgery for a varicocele is impaired fertility. Rarely will there be a varicocele so large that symptoms arise which require intervention.

The surgical procedure is a relatively simple one, which can be done on an outpatient basis or with a short hospital stay. The urologist makes an incision in the groin and ties off the abnormal veins, preventing the blood from returning via this route. Since other veins take over the drainage function, the testicle is not damaged. Laparoscopic techniques allow treatment through smaller incisions in an attempt to reduce discomfort. With either open or laparoscopic techniques, the varicocele mass shrinks and the pain subsides over the first few weeks.

Questions to Ask Your Doctor

Where is the varicocele located?

Is this related to sperm production and infertility?

Is surgical intervention indicated?

How will this be performed?

Is laparoscopic surgery possible?

What are the possible complications of surgery?

How long is the recovery period?