What Is Varicocele?

Varicocele is a medical condition in which the veins of a man’s scrotum become engorged with blood, causing them to swell up. This swelling can result in an enlarged scrotum, testicular shrinkage, and recurrent, if relatively mild, pain. Because the scrotum holds the testicles, varicocele’s most important impact may be on male fertility. The veins with the greatest chance of being affected are on the scrotum’s left side. Men with varicocele typically first see evidence for it in their teen years or twenties.

Varicocele is a common condition; it is estimated that about three out of 20 adult males have experienced it. Male infertility is complicated but it also appears that as many as 40 percent of all males with fertility issues have varicocele. If you are concerned about this condition, make an appointment with a member of the Baptist Health urology team for consultation and treatment.

What Are Varicocele Symptoms?

There are several symptoms associated with varicocele:

• A swelling-up of the scrotum
• Twisted, dark-colored veins visible in the scrotum
• A testicular lump
• Testicular shrinkage (atrophy)
• Chronic mild pain or achiness in the scrotum

It is possible to develop varicocele without being aware of the condition. It might go undetected unless diagnosed by a physician during a physical examination.

What Causes Varicocele?

Testicles are linked to the body’s circulatory system by a network of blood vessels, both arteries and veins. These vessels contains one-way valves for moving oxygenated blood from the heart through the testicles, or back to the heart with respiratory waste products. Varicocele results when valves in the veins fail to clear the blood from the testicles, causing it to pool over time. (The return portion of the blood’s journey is complicated by fighting gravity.) Varicocele tends to appear gradually, which is one reason why men can be unaware of its development.

Though scientists can describe the cause of varicocele, the risk factors behind it are unclear. Why some men experience varicocele while others do not remains unknown.

How Is Varicocele Diagnosed?

The diagnosis of varicocele usually involves:

• A physical examination: Your physician will record your medical history and symptoms and then examine your scrotum and testicles for evidence of swelling or other indicators of varicocele. He or she may do this while you’re standing up, lying down, or in both positions. 
• Imaging: Your doctor may also order a scrotal ultrasound. This will allow him or her to get detailed pictures of the spermatic veins, which are the blood vessels tasked with removing deoxygenated blood from the testicles. The failure of the spermatic veins to clear blood from the testes is the primary cause of varicocele.

If there is evidence of a blood pool, your physician will categorize the resultant lump as grade 1 (small), grade 2 (medium), or grade 3 (large). These grades reflect the extent rather than the severity of varicocele. Not all cases of varicocele require treatment.

How Is Varicocele Treated?

Medical treatment of varicocele is typically limited to those persons for whom the condition is generating pain, causing testicular shrinkage, or contributing to infertility. The chief means of treating varicocele are:

• Open surgery: Surgery focuses on sealing off the malfunctioning veins, allowing the blood to reroute to healthier vessels, thereby improving circulation in the scrotum. Your surgeon will typically enter your body through your groin. A complete post-surgical recovery typically requires two weeks or more of time. Complications include mild pain, which can be controlled by over-the-counter medications.
• Laparoscopic surgery: An alternative form of surgery utilizes a laparoscope, which is a small instrument for repairing internal tissue damage.
• Percutaneous embolization: Embolization involves the surgical introduction of a chemical inside the spermatic veins, sealing them off by means of an artificially produced scar tissue. Blood from the testicles is then released by means of healthier, unblocked vessels.  

Varicocele is rarely if ever life-threatening. In the absence of symptoms, it is a medical condition that most men can tolerate. The primary medical concern is a possible connection with infertility.

Learn More About Varicocele from Baptist Health

For more information about varicocele diagnosis and treatment or to schedule an appointment with our physicians, please contact the Baptist Health urology team.