What is a varicocele, and why does it matter?
It arises when valve failure in the veins allows blood to flow backwards and the veins to enlarge. For anatomical reasons the great majority of cases are on the left side. It is seen in around 15% of young adult men.
Because enlarged veins can raise the temperature around the testis and affect blood flow, they may affect sperm production adversely. Even so, a significant proportion of men with a varicocele develop no problem at all; the presence of a varicocele alone is therefore not considered a reason to operate.
Symptoms and examination
Most varicoceles cause no symptoms and are noticed during an examination carried out for another reason. Where symptoms are present, a feeling of heaviness in the scrotum, a dull ache that worsens towards the end of the day, or the description of a palpable “bag of worms” stand out.
Examination is performed standing and with a Valsalva (straining) manoeuvre; grading follows the findings. Where needed, colour Doppler ultrasound is used to assess vein diameter and reflux. During adolescence, any difference in testicular size is followed separately.
When does surgery come into play?
Surgery is considered in selected cases where one or more of the following findings is present:
- A clinically palpable varicocele together with deterioration in sperm parameters
- A male factor standing out in a couple planning to have children
- Chronic testicular pain affecting daily life that cannot be explained by another cause
- Marked lag in testicular development on the affected side during adolescence
- A plan to support sperm quality in preparation for assisted reproduction
Microsurgical varicocelectomy and afterwards
In subinguinal varicocelectomy performed with the aid of a microscope, the enlarged veins are tied off while the aim is to preserve the arteries and lymphatic structures. The purpose is to reduce unwanted outcomes such as hydrocele formation and recurrence as far as possible.
After surgery it is advised to observe the period given for heavy lifting and strenuous sport. Because sperm production runs in cycles of roughly three months, reassessment of sperm parameters is usually planned after the third month. The outcome varies from person to person; pregnancy cannot be guaranteed.
Frequently asked questions
Should every varicocele be operated on?
No. Where a varicocele causes no symptoms and sperm parameters are normal, observation is usually enough. The decision to operate is made by weighing the examination, the sperm results and any plans for having children together.
When are sperm values checked after surgery?
Because of the sperm production cycle, the first check is usually planned after the third month; assessment is then repeated at set intervals.
Does varicocele surgery correct erectile dysfunction?
Varicocele surgery is not a treatment for erectile dysfunction. The two conditions can occur together, but erectile dysfunction is assessed separately.
Can a varicocele come back?
Every surgical method carries some possibility of recurrence. The aim of the microsurgical approach is to reduce that possibility and complications such as hydrocele. That is why follow-up appointments matter.