Varicocele

Answer 1

Definition

A varicocele is a widening of the veins along the cord that holds up a man's testicles.

Alternative Names

Varicose veins - scrotum

Causes, incidence, and risk factors

A varicocele forms when valves inside the veins along the spermatic cord prevent blood from flowing properly. This causes the blood to back up, leading to swelling and widening of the veins. (This is essentially the same process that leads to varicose veins, which are common in the legs.)

Varicoceles usually develop slowly. They are more common in men ages 15 - 25 and are most often seen on the left side of the scrotum. Varicoceles are often the cause of infertility in men.

The sudden appearance of a varicocele in an older man may be caused by a kidney tumor, which can block blood flow to a vein. This is more common on the left side than the right.

Symptoms

• Enlarged, twisted veins in the scrotum
• Infertility
• Painless testicle lump, scrotal swelling, or bulge within the scrotum

There may not be symptoms.

Signs and tests

The health care provider will examine the groin area, including the scrotum and testicles. The doctor may be able to feel a nontender, twisted mass along the spermatic cord. (It feels like a bag of worms.)

However, the mass may not be able to be seen or felt, especially when lying down.

The testicle on the side of the varicocele may be smaller than the one on the other side.

Treatment

A scrotal support (jock strap) or snug underwear may provide some relief of the pain or discomfort. If pain continues or other symptoms occur, further treatment may be needed.

Surgery to correct a varicocele is called a varicocelectomy. The surgery is usually done on an outpatient basis. You will receive some type of numbing medication (anesthesia). The urologist will make a cut, usually in the lower abdomen, and tie off the abnormal vein. Blood will now flow around the area into normal veins. Keep an ice pack on the area for the first 24 hours after surgery to reduce swelling.

An alternative to surgery is varicocele embolization. This method is also done on an outpatient basis. However, it uses a much smaller cut than surgery, so you heal faster. A small hollow tube called a catheter (tube) is placed into a vein in your groin or neck area.

Using x-rays as a guide, the health care provider moves the tube into the varicocele. A tiny coil passes through the tube into the varicocele. The coil blocks blood flow to the bad vein, and sends it to normal veins.

After the procedures, you will be told to place ice on the area and wear a scrotal support for a little while. Complications from treatment may include:

• Atrophic testis
• Blood clotformation
• Infection
• Injury to the scrotal tissue or nearby blood vessel

Expectations (prognosis)

A varicocele is usually harmless and often requires no treatment. If surgery is required because of infertility or testicular wasting away (atrophy), the sperm count will likely improve but the ultimate pregnancy rate is unchanged. In most cases, testicular wasting (atrophy) does not improve unless surgery is done early in adolescence.

Calling your health care provider

Call for an appointment with your health care provider if you discover a testicle lump or need to treat a diagnosed varicocele.

References

Khera M, Lipshultz LI. Evolving approach to the varicocele. Urol Clin North Am. 2008;35:183-189.

Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.

Answer 2

Definition

A varicocele is a widening of the veins along the cord that holds up a man's testicles (spermatic cord).

Alternative Names

Varicose veins - scrotum

Causes, incidence, and risk factors

A varicocele forms when valves inside the veins along the spermatic cord prevent blood from flowing properly. This causes the blood to back up, leading to swelling and widening of the veins. (This is essentially the same process that leads to varicose veins, which are common in the legs.)

Varicoceles usually develop slowly. They are more common in men ages 15 - 25 and are most often seen on the left side of the scrotum.

The sudden appearance of a varicocele in an older man may be caused by a kidney tumor, which can block blood flow to a vein. This is more common on the left side than the right.

Symptoms

• Enlarged, twisted veins in the scrotum
• Painless testicle lump, scrotal swelling, or bulge in the scrotum

There may not be symptoms.

Signs and tests

The health care provider will examine the groin area, including the scrotum and testicles. The health care provider may feel a twisted growth along the spermatic cord. (It feels like a bag of worms.)

However, the growth may not be able to be seen or felt, especially when you are lying down.

The testicle on the side of the varicocele may be smaller than the one on the other side.

Treatment

A jock strap (scrotal support) or snug underwear may help relieve the pain or discomfort. If pain continues or other symptoms occur, you may need further treatment.

Surgery to correct a varicocele is called varicocelectomy. You will leave the hospital on the same day as your surgery. During this procedure, you will receive some type of numbing medication (anesthesia). The urologist will make a cut, usually in the lower abdomen, and tie off the abnormal veins. Blood will now flow around the area into normal veins. Keep an ice pack on the area for the first 24 hours after surgery to reduce swelling.

An alternative to surgery is varicocele embolization. This method is also done without an overnight hospital stay. It uses a much smaller cut than surgery, so you will heal faster. A small hollow tube called a catheter (tube) is placed into a vein in your groin or neck area.

Using x-rays as a guide, the health care provider moves the tube into the varicocele. A tiny coil passes through the tube into the varicocele. The coil blocks blood flow to the bad vein, and sends it to normal veins.

After the procedure, you will be told to place ice on the area and wear a scrotal support for a little while.

Expectations (prognosis)

A varicocele is usually harmless and often does not need to be treated.

If you have surgery, your sperm count will likely increase but it will not improve your chances of getting a woman pregnant. In most cases, testicular wasting (atrophy) does not improve unless surgery is done early in adolescence.

Complications

Infertility is a complication of varicocele.

Complications from treatment may include:

• Atrophic testis
• Blood clotformation
• Infection
• Injury to the scrotum or nearby blood vessel

Calling your health care provider

Call for an appointment with your health care provider if you discover a testicle lump or need to treat a diagnosed varicocele.

References

Khera M, Lipshultz LI. Evolving approach to the varicocele. Urol Clin North Am. 2008;35:183-189.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37:613-626.

Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.

Reviewed By

Review Date: 09/16/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.