What Is a Varicocele?

abnormal sperm
Abnormal Sperm

A varicocele is a varicose vein (larger than normal vein that is visible through the skin) inside the scrotum. These enlarged veins are the spermatic cord (the tube that transports sperm to the testes). Varicoceles can cause blood to collect in the scrotum or flow backward to the testes because the veins are larger than normal.

Varicoceles are extremely common—15 percent of men have varicoceles and a left-sided varicocele is much more common than a right-sided varicocele. 

Are Varicoceles Harmful?

If you’re living with a varicocele, it is harmless to your health. However, a varicocele may lead to:

About 40 percent of men who visit infertility clinics have varicoceles. These scrotal varicose veins can disrupt spermatogenesis (sperm creation). Men who have varicoceles usually have a low sperm count, reduced sperm motility (sperm activity), and abnormal sperm. But they don’t always cause infertility issues.

Fewer than five percent of men feel varicocele pain in the scrotal sac. Generally, varicoceles do not cause any other health problems.

Varicocele Causes

Researchers don’t know exactly what causes varicose veins inside the scrotum. But it is possible that varicoceles elevate temperatures in the scrotum, which disrupts normal sperm creation.

You may want to consider having varicocele treatment if you have problems with:

  • infertility,
  • pain, or
  • testicular atrophy (testes getting smaller).

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Varicoceles Diagnosis

Healthy testicle vs. a testicle with varicocele
Healthy testicle vs. a testicle with varicocele

We find varicoceles by examining your scrotum while you’re standing. It’s more difficult for us to find  varicoceles when you’re laying down because they are less prominent and may even disappear in that position.

To diagnose most varicoceles, we do not require you to have an ultrasound. An ultrasound is only necessary if you have a subclinical varicocele — a varicocele that shows on an ultrasound but cannot be felt during the physical examination.

We also don’t rely on a semen analysis to determine whether a varicocele is causing abnormalities in spermatogenesis. Instead we focus on an FSH, which is a test that will show an endocrine marker of how stressed your sperm production factory is.

In fact, many men may have abnormalities in their semen analysis that are totally unrelated to their varicocele.

Varicocele Treatment

We usually only perform surgery for varicoceles when you have the following:

  • Abnormalities in your semen analysis.
  • An elevated FSH showing that the varicocele is causing some stress on the sperm production factory.
  • A sperm count where surgical repair of the varicocele could give you a better chance of conceiving.

We can fix varicoceles with a variety of surgical procedures. However, we do recommend a sub-inguinal microscopic varicocelectomy because it has the lowest complication rate and the highest chance of success.

Note: We will refer you to interventional radiology if you have already failed one ligation (surgical procedure that ties up a blood vessel) of the varicocele through the sub-inguinal microsurgical approach.

Varicocelectomy

Figure 1: Varicocelectomy

Swollen vein in the spermatic cord
A. Swollen vein in the spermatic cord
Ligated venous branches of the spermatic cord
B. Ligated venous branches of the spermatic cord

Preparing for Your Surgery

Follow the steps below to ensure you’re ready for surgery day.

  • Eat normally the evening before your surgery.
  • Do not eat or drink anything after midnight.
  • Do NOT drink coffee, juice, or milk the morning of surgery.
  • Do NOT eat the morning of surgery.
  • If you have any medications that you must take in the morning before your surgery, swallow them with a small sip of water only.
  • Wear loose, comfortable clothing.

Varicocele Surgery

Before we begin the procedure, we will give you general anesthesia to put you to sleep and local anesthesia to numb the area and keep you comfortable when you wake up. For the varicocelectomy, we make a 1–2 cm incision in the groin and then bring the spermatic cord up to the skin (see figure 1). We use an operating microscope to perform the varicocelectomy at 30–40x magnification.

We then open the external spermatic fascia (outside layer) under the microscope and cut out and divide each engorged spermatic cord vein. We tie off the veins with clips or ties while keeping other parts of the spermatic cord intact. We close the incision using dissolvable stitches.

The entire procedure takes 45 minutes to one hour and patients can go home the same day.

Varicocelectomy Risks

Serious complications are rare, but some risks include:

  • bleeding,
  • infection,
  • injury to the testicle,
  • blood clots in the legs, and
  • the risks of general anesthesia. 

Only about 10 to 15 percent of men who have varicocele surgery will have a recurring or persistent varicocele after surgery.

Varicocele Surgery Recovery

Most men have minimal pain after this procedure and often forget to take the pain pills that we provide. 

For the first 24 hours after surgery, do not: 

  • drive,
  • use machinery,
  • eat any heavy or large meals,
  • drink alcohol, or
  • make important decisions because the anesthesia will make it hard to think clearly.

You should recover in about one to two days. Any bruising, swelling, or pain you experience is normal and should cease after several days.

For a quick and easy recovery, you should:

  • Take Ibuprofen 800mg every eight hours and Tylenol 650mg every six hours around the clock for three days.
  • Take narcotic medication only as needed.
  • Ice every 20 minutes out of every hour to ease the pain.
  • No sex, masturbation, or lifting things more than 25 pounds for one week.
  • You may shower the day after surgery, but no baths for a week.

What To Expect After a Varicocelectomy

You will need a semen analysis at every two months after this procedure to see if the quality of your sperm has improved because of the procedure. At least two-thirds of men see improvements in their semen analysis and about 40 percentcan impregnate a woman successfully.

An alternative to surgery is an embolization performed by a radiologist. During embolization, the radiologist uses a catheter to put a coil or fluid in the vein to block blood flow through the vein. This can sometimes be used for recurring varicoceles after surgery, which is not common.

*Efficacy and safety of varicocelectomies: A meta-analysis.Yuan R et al. Syst Biol Reprod Med. (2017)

The impact of varicocelectomy on sperm parameters: a meta-analysis. Schauer I, Madersbacher S, Jost R, Hübner WA, Imhof M. J Urol. 2012 May;187(5):1540-7. 

Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Baazeem A, Belzile E, Ciampi A, Dohle G, Jarvi K, Salonia A, Weidner W, Zini A. Eur Urol. 2011 Oct;60(4):796-808.

Next Steps

If you would like to consult with one of our men’s health specialists, contact us to make an appointment