Symptoms

Varicoceles typically manifest on the left side of the scrotum and often do not exhibit any signs or symptoms. Potential indications may include:

Pain: Typically, dull, aching pain or discomfort that tends to worsen while standing or toward the end of the day. Pain often subsides when lying down.

Scrotal mass: In cases where the varicocele is sufficiently large, a visible group resembling a “bag of worms” may be observed above the testicle. Smaller varicoceles may not be visible but can be detected by touch.

Testicle size discrepancy: The affected testicle may appear noticeably smaller than the unaffected one.

Infertility: While not all varicoceles lead to infertility, they can cause difficulties fathering a child.

Knowing When to Consult a Doctor

It is crucial to schedule and maintain annual wellness visits for boys to monitor the growth and well-being of their testicles. These appointments hold significant importance.

Seeking Medical Attention

Various factors can lead to discomfort, inflammation, or the presence of a lump in the scrotum. If you encounter any of these symptoms, it is advisable to consult a healthcare professional promptly to obtain an accurate diagnosis.

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Varicocele Causes

Varicocele is caused by the enlargement of the pampiniform plexus, which is a network of small veins within each side of the scrotum. The testicles receive oxygen-rich blood from two testicular arteries, one for each side of the scrotum. Similarly, there are two testicular veins that carry oxygen-depleted blood back toward the heart. The pampiniform plexus transports the oxygen-depleted blood from the testicle to the main testicular vein.

The exact cause of varicocele is not known. One possible factor is the malfunction of valves inside the veins that are supposed to maintain the proper blood flow direction. Additionally, the left testicular vein follows a slightly different path than the right vein, which increases the likelihood of blood flow problems on the left side.

When the network of veins becomes congested with oxygen-depleted blood, they expand and dilate, resulting in the formation of a varicocele.

Complications of Varicocele

Varicocele can lead to difficulties in regulating testicular temperature, which in turn can cause oxidative stress and toxin accumulation. These factors can contribute to the following issues:

Impaired testicular health: In adolescents going through puberty, a varicocele can hinder the growth of the testicles, hormone production, and other aspects related to testicular health and function. In adult men, a varicocele may gradually lead to shrinkage due to tissue loss.

Infertility: While not all varicoceles cause infertility, approximately 10% to 20% of men diagnosed with a varicocele experience challenges in fathering a child. Among men with fertility problems, around 40% are found to have a varicocele.

Diagnosis

The treatment approach for varicocele can vary depending on the individual’s circumstances. In many cases, no treatment is necessary. However, if a man is experiencing infertility, addressing the varicocele through surgery may be included as part of the fertility treatment plan.

For teenagers or young adults who are not actively seeking fertility treatment, a healthcare professional may recommend regular check-ups to monitor any changes. Surgery may be advised in the following scenarios:

• Testicular growth delay is observed.
• Low sperm count or other abnormalities in sperm function are detected (typically assessed in adults).
• Persistent chronic pain that is not effectively relieved by pain medication.

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Surgery

Surgery aims to close the affected vein and redirect blood flow towards healthy veins, which is facilitated by two other artery-and-vein systems responsible for blood circulation to and from the scrotum.

Potential treatment results may include:

• The affected testicle may eventually regain its normal size. In teenagers, the testicle may catch up in development.
• Sperm counts may improve, and irregularities in sperm may be corrected.
• Surgery can enhance fertility or enhance semen quality for in vitro fertilization.

Surgery Risks

The risks associated with varicocele repair are relatively minimal and may include:

• Accumulation of fluid around the testicles (hydrocele)
• Recurrence of varicoceles
• Infection
• Damage to an artery
• Persistent testicular pain
• Accumulation of blood around the testicle (hematoma)

The balance between the advantages and drawbacks of surgery shifts when the treatment is solely for pain management. While varicoceles can cause pain, this is not the case for most individuals. A person with a varicocele may experience testicular pain, but it could be due to another unidentified cause. When varicocele surgery is primarily performed to alleviate pain, there is a risk that the pain may worsen or change in nature.

Surgical Procedures

Your surgeon can halt the blood flow in the testicular vein by either suturing or clamping the vein shut (ligation). Presently, two commonly employed approaches exist, both requiring general anesthesia and outpatient procedures that typically allow you to return home on the same day. These procedures are as follows:

Microscopic varicocelectomy: The surgeon makes a small incision near the groin area. Utilizing a powerful microscope, the surgeon identifies and ligates multiple small veins. This procedure typically takes around 2 to 3 hours.

Laparoscopic varicocelectomy: The surgeon carries out this procedure using a video camera and surgical tools attached to tubes that pass through a few very small incisions in the lower abdomen. Since the network of veins above the groin is less intricate, there are fewer veins to ligate. This procedure usually lasts approximately 30 to 40 minutes.

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Recovery

The discomfort following this surgical procedure is generally mild, although it may persist for several days or even weeks. Your doctor may prescribe pain medication for a limited time after the surgery. Following that, your doctor might suggest taking over-the-counter pain relievers like acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to alleviate any discomfort.

Typically, you should be able to go back to work approximately one week after the surgery and resume exercising around two weeks after the procedure. It is advisable to consult your surgeon regarding when it is safe to return to your daily activities or engage in sexual activity.