A varicocele is a collection of dilated blood vessels in the scrotum and around the testicles. Varicoceles are very common. In fact, 15% of all adult men have a varicocele About 20% of adolescents have varicoceles, so a fraction of them likely resolve spontaneously. Varicoceles can be associated with male infertility in 40% of couples and they are the most correctable cause of male infertility.
At South Charlotte General and Vascular Surgery, our vascular surgeons have extensive experience in the diagnosis and treatment of these conditions and are able to treat the condition with a procedure done in our state of the art in-office accredited angiography suite. Request an appointment with our varicocele specialists today.
Are varicoceles Dangerous?
Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose, and many do not need treatment. However, varicoceles may be a health concern because they may cause infertility (problems fathering a child) and slow growth of the left testicle during puberty. It is important to remember that 8 out of 10 men who have a varicocele do not have fertility problems.
Varicoceles are not usually dangerous, but they can be associated with serious conditions. For example, if a varicocele forms on the right side and not the left, it is important to make sure there is no mass or other abnormality in the abdomen that might be causing it. Also, varicoceles should “reduce” or decrease in fullness when a patient is lying down since the gravity no longer fills the pampiniform plexus of veins.
When a varicocele doesn’t reduce, it also raises concern that there is an abdominal blockage such as a mass or tumor that could be causing the mass. Finally, it seems varicoceles almost always have effects on testosterone production. However, many men with varicoceles will maintain satisfactory levels of testosterone throughout their lives without treatment. In rare cases, however, varicocele could lead to severely low testosterone, with its associated complications including metabolic syndrome, diabetes, and osteoporosis.
What symptoms are associated?
- Pain in the affected testicle that may vary from sharp to dull discomfort
- Increase in pain with standing or physical exertion, especially over long periods
- Pain worsening over the course of a day
- Pain may be relieved when you lie on your back
- With time, varicoceles might enlarge and become more noticeable. A varicocele has been described as looking like a "bag of worms." The condition might cause a swollen left testicle
When to see a doctor?
If you experience pain or swelling in your scrotum, discover a mass on your scrotum, notice that your testicles are different sizes, or develop a varicocele in your youth, or you're having problems with fertility, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment
When is treatment indicated?
Treatment of varicoceles is indicated if:
- Palpable painful varicocele
- Documented infertility with no female infertility issues or potentially curable problem
- Abnormal sperm analysis
- The left testicle growing smaller than the right
How are varicoceles treated?
The goals of treating the varicocele is to eliminate the pressure in the veins of the testicle by closing off the bad veins and diverting the blood flow into healthier veins.
Up until recently, the treatment of varicoceles has primarily consisted of surgical removal of the dilated veins. Although successful, the surgical procedure has risks associated with it, some of which may be quite disabling. Here are some of the options to consider:
- Open varicocelectomy: This approach involves an incision in the inguinal, or groin, region. The surgeon locates the veins causing the varicocele and ties them off.
- Laparoscopic varicocelectomy: This approach involves small incisions made in the abdomen. Using a specialized camera (scope), the veins that are causing the varicocele are identified and then tied off.
- Microsurgical varicocelectomy: This approach uses the same initial incision as the open approach, however it uses a microscope to locate the veins and tie them off. This procedure is more time intensive than the other procedures.
- Varicocele Embolization: At South Charlotte General and Vascular Surgery, our specialists have had excellent results with treating this condition with an in-office procedure, where they are able to place metal coils inside the enlarged veins to shrink them. This is a treatment that does not require surgery.
Varicocele embolization is a minimally invasive technique performed by our vascular specialist. In our state of the art in-office angiographic suite. Numbing medication is injected into the skin in the groin and then a catheter, or a thin tube, is inserted into the vein in the leg. Using x-ray imaging, the catheter is advanced into the vein(s) that are causing the varicocele. Once the catheter is successfully placed the affected veins are closed off by the placement of a small coil or coils, and/or the use of a sclerosing agent.
Varicocele embolization is successful about 80-90% of the time. Within 1-2 days, you should feel close to normal, and you will be able to exercise within 7-10 days. You can resume sexual intercourse after 1-2 weeks.
Before deciding on a treatment, you should consider all of your options. If you are interested in discussing varicocele embolization, please call us and schedule a consultation with one of our varicocele specialists. At South Charlotte General and Vascular Surgery, we are committed to your vascular health.