Varicoceles are large, twisted veins that drain blood from the testicles. They are much like varicose veins of the leg. Most often, they occur after puberty on the left side of the scrotum. Once a varicocele is present, it will not go away on its own.
Most people with varicoceles have no symptoms. Some do feel pain. The pain can vary from a dull, heavy discomfort to a sharp pain. The pain may increase with sitting, standing or strenuous activity. It usually resolves when lying flat on the back.
The testicle on the side with the varicocele may be smaller in size than the one on the opposite side. The affected testicle may not grow well and may not produce good sperm when it is time. The scrotum (sac) may appear swollen.
Varicoceles are usually found by the patient's family doctor on a routine physical exam. The individual stands, takes a deep breath and holds it, while the doctor examines the scrotal sac. Varicoceles vary in size and may become larger and more visible as time passes. An ultrasound of the scrotum may be done.
Causes of Varicoceles
One theory suggests that they are caused by poorly functioning valves in the scrotal veins. The valves allow blood to pool and cause enlarged veins. Another theory is that the vein from the left kidney to the scrotum is positioned so that the pull of gravity is stronger than on the right side.
Nonsurgical treatment for a varicocele is to use a scrotal support and for any associated pain, ibuprofen or acetaminophen.
Decisions about surgical repair of the varicocele are based upon differences in testicular size, amount of pain and semen analysis (in the teenage or adult patient only).
Surgery involves cutting the veins that cause the varicocele. An incision is made in the groin. After the scrotal veins are found, they are cut to stop the blood flow. Risks include return of varicocele, bleeding, infection, occurrence of hydrocele (fluid around the testicle) and anesthesia reactions.
Another option is a percutaneous embolization. This is done in a special X-ray department room. A catheter is inserted into a vein in the patient's groin. The X-ray doctor locates the enlarged veins in the scrotum. Then, a blockage is created in those veins. The blockage will stop the blood flow and the enlarged veins should disappear. This procedure risks include infection, blood clot and injury to scrotal tissue. The X-ray doctor will give discharge instructions.
Both procedures allow same-day discharge.
After surgery, pain medication is prescribed. Patients should avoid physically strenuous activities for 4 weeks. No bathing for 5 days after surgery. Showers are allowed. A follow-up office visit should be scheduled.