What is a varicocele?

A varicocele is a pathological dilation of the testicular or spermatic veins located inside the scrotum, the skin sac that surrounds the testicles. The purpose of the veins is to drain blood from the testicles and in the presence of a varicocele, the situation is like the varicose veins that occur on the legs. This alteration causes swelling in the affected testicle. Usually, swelling of the testicle is the only pathological manifestation of a varicocele. However, in some cases, the swelling may be accompanied by pain and, in the most severe cases, testicular atrophy and infertility. This infertility is given by asthenozoospermia which is characterized by insufficient mobility of the spermatozoa in the ejaculate. Fortunately, this is a reversible situation once the problem is treated.

Varicocele is a very common condition in men, especially in young adults (18-25 years). It tends to occur on the left side of the reproductive system, due to the location of the left testicular vein, although it can also occur on the right side.

The causes

Many experts believe that a varicocele forms when valves in the funicular veins, which carry blood to and from the testicles, prevent the blood from flowing properly. The resulting backflow causes the veins to dilate and damage the testicle, which can lead to fertility problems. Varicoceles often form at the age of sexual development and usually appear on the left side, most likely due to the location of the left testicular vein. However, the presence of a varicocele, even in one testicle, can affect sperm production in both.

Risk factors

There do not appear to be any significant risk factors for developing a varicocele. However, some research suggests that being overweight may reduce the risk, while being large in stature may increase it.

The symptoms

Varicocele is often asymptomatic, i.e. it causes no discomfort to the patient. In other cases, the patient may complain of:

a local increase in temperature
a feeling of discomfort or weight in the scrotal area
a soft swelling over the testicle
pain

Symptoms tend to appear more

after physical exertion
after a long period of immobility
after sexual activity
in a hot environment
in the evening.

How it can be treated

Varicoceles often do not require treatment. However, if there is pain, testicular atrophy or infertility, or if you are considering assisted reproductive techniques, surgery is recommended. The aim of surgery is to close the affected vein in order to redirect the blood flow to the normal veins. In cases of male infertility, treatment of varicocele may even resolve it or, if you use techniques such as in vitro fertilization (IVF), improve the quality of the sperm. Usually, varicocele develops in adolescence and leads to a deterioration in sperm quantity and quality. However, many people still have sufficient sperm quality to have children.

When should surgery be performed for varicocele?

Progressive testicular atrophy, pain or abnormal semen test results are clear indications for varicocele surgery in adolescence. Although treatment of varicocele usually improves sperm characteristics, it is not known whether untreated varicocele leads to progressive deterioration of sperm quality over time. If there are no specific symptoms such as testicular atrophy or reduced sperm quantity and quality on the sperm analysis or signs of hypogonadism, in most cases varicocele does not require treatment, either surgical or pharmacological. If these symptoms are present, surgery can be performed, which can be of three types:

Open surgery, which is performed under general anesthesia, or locally, with a small incision of a few centimeters in the abdomen or at the pubic area, towards the groin. No convalescence is necessary, after a few days of the operation you can resume your normal daily activities and after two weeks you can resume sports and – if the doctor is informed – sexual activities. It takes a few months to see an improvement in the quality of the sperm.
Laparoscopic surgery, under general anesthesia, which consists of small incisions in the abdomen through which the instrument to repair the varicocele can be inserted.
Percutaneous embolization, offered as an outpatient procedure under local anesthetic. It consists of repairing the varicocele by passing through the blood vessels.