Conditions we treat
Varicocele
What is a varicocele?
A varicocele is an enlargement of the veins within the scrotum that drain blood from the testicle. It occurs when blood flows backwards and pools within these veins, causing them to become enlarged.
Varicoceles are relatively common and often develop during puberty. They are more commonly found on the left side, although they can occur on both sides.
Many varicoceles cause no symptoms and do not require treatment. In some men, however, a varicocele can cause scrotal pain or discomfort, changes in testicular size or function, or may be associated with fertility problems.
What Causes a Varicocele?
A varicocele develops when blood does not drain normally through the veins of the testicle. These veins contain valves that help blood flow away from the scrotum and back towards the heart. If the valves do not function effectively, blood can flow backwards and pool within the veins, causing them to enlarge.
Varicoceles occur more commonly on the left because of the way the left testicular vein drains into the left renal vein. Less commonly, varicoceles can occur on the right or on both sides.
In some circumstances, particularly when a varicocele develops suddenly or has unusual features, further investigation may be recommended to exclude another cause of impaired venous drainage.
Varicocele Symptoms
Many varicoceles cause no symptoms and may only be discovered during a physical examination or investigation for fertility concerns. When symptoms do occur, they may include:
- A dull ache, heaviness or dragging sensation in the scrotum, often worse after prolonged standing or physical activity
- Enlarged or twisted veins within the scrotum
- Swelling or a feeling of fullness in the scrotum
- A difference in size between the testicles
- Fertility problems in some men
Symptoms can vary considerably, and the presence of a varicocele does not necessarily mean that treatment is required.
Varicocele and Infertility
Varicoceles are associated with male infertility and may affect sperm production and quality in some men. This may relate to increased temperature around the testicle, altered blood flow and other changes in the testicular environment.
However, having a varicocele does not necessarily mean that a man will have fertility problems. When fertility is a concern, assessment may include semen analysis and consideration of other factors affecting fertility.
Treatment of a clinically significant varicocele may improve semen parameters in appropriately selected men. The decision to treat should take into account the varicocele, semen analysis, fertility history and the individual circumstances of both partners.
Varicocele and Testosterone
Some studies have found an association between varicocele and reduced testosterone levels in some men. One proposed explanation is that altered blood flow and increased temperature around the testicle may affect the function of the cells responsible for testosterone production.
However, not all men with a varicocele have low testosterone, and symptoms potentially associated with testosterone deficiency can have many other causes. If low testosterone is suspected, appropriate clinical assessment and blood testing may be recommended.
The presence of a varicocele alone is not necessarily an indication for treatment, and the potential role of varicocele treatment should be considered in the context of each patient’s symptoms, examination and investigations.
Varicocele Diagnosis
A varicocele can often be diagnosed through a clinical examination. The examination may be performed while standing and may include assessment during straining, as this can make a varicocele more apparent.
Scrotal ultrasound may be used to confirm the diagnosis, assess the size of the veins and evaluate blood flow. Ultrasound can also help identify other causes of scrotal pain or swelling.
Further investigation may occasionally be recommended when the findings are unusual, such as a varicocele that develops suddenly or has atypical features.
Dr Ryan McConnell can assess patients with a varicocele and arrange appropriate imaging where required. If treatment is being considered, the findings can then be used to determine the most appropriate treatment options.
Varicocele Treatment Options
Treatment is not required for every varicocele. It may be considered when a varicocele is causing persistent pain or discomfort, is associated with changes in testicular size or function, or may be contributing to fertility problems.
The two main treatment approaches are varicocele embolisation and surgical repair.
Varicocele embolisation is a minimally invasive, image-guided procedure performed by an interventional radiologist. It treats the abnormal veins from within the blood vessels without requiring a surgical incision.
Surgical repair involves tying or sealing the abnormal veins through a surgical approach. The most appropriate treatment depends on the individual patient’s symptoms, anatomy, fertility considerations and previous treatment.