A varicocele is a scrotal swelling caused by the dilation of veins that return blood from either one or both testicles back toward the heart. Approximately 15 to 20% of men and boys have a varicocele. Over ninety percent of varicoceles are left-sided and the vast majority are asymptomatic except for the noticeable change caused to the shape of the scrotum. A varicocele is most commonly discovered after puberty and can be associated with delayed growth and development of the testicle below it. The condition does not resolve spontaneously and left untreated can cause a number of problems.

While most varicoceles never require treatment, surgical repair is indicated in the presence of loss of testicular growth in boys, and for chronic pain or subfertility in men. In fact, a varicocele is the most common surgically correctable abnormality found among men with subfertility. Approximately 70% of men with subfertility who undergo surgical repair of a varicocele will have improvement in their semen characteristics and 30 to 40% will eventually be capable of initiating a pregnancy.

Generally, a varicocele can be diagnosed by routine physical examination performed in the office. With the patient in the standing position a varicocele can be felt surrounding the testicle under the scrotal skin. A very large varicocele can give the scrotum the look and feel of a “bag of worms”. On occasion there is need for imaging studies, such as scrotal ultrasonography, to confirm the presence of a smaller varicocele.

Varicocele Surgical Treatments

Surgical repair of a varicocele is routinely performed on an outpatient basis under regional or general anesthesia. A small incision is made on the lower part of the abdominal wall on the same side as the varicocele, very similar to the incision used to repair an inguinal hernia. The dilated veins are identified and isolated from the adjacent testicular artery and vas deferen to avoid inadvertent injury to these important structures. Segments of the veins are excised and the open ends on either side are then closed off with sutures. This effectively creates and interruption of the flow of blood through these unhealthy veins and forces blood leaving the testicle to travel through healthy veins instead.

Although surgery to repair a varicocele is considered a safe and effective procedure there can be associated complications. Typically the postoperative pain and swelling will persist for 5 to 7 days and during this time patients are encouraged to avoid strenuous physical activity. Infection at the surgical site is rare and is rendered unlikely by the use of antibiotics after surgery. Injury to the testicular artery or the vas deferen can compromise fertility and are serious complications of varicocele repair. Finally, there can be persistence or recurrence of the varicocele after surgery in up to 5% of cases.

Varicocele repair is a surgical procedure that is generally covered by insurance. Patients troubled by a varicocele are encouraged to call the office to schedule an appointment at our office in Bucks County for an exam and discussion regarding this condition.

What are the symptoms of a varicocele?

According to the May Clinic, a varicocele usually doesn’t cause any symptoms, but it rare cases, you may experience the following:

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