A varicocele is the enlargement of the network of veins that drain the testicle in males.
Blood flows from the scrotum and testicles through a complex of veins rather than a single vessel. These veins are prone to becoming enlarged or dilated. This frequently happens when the valves in the veins that keep the blood flowing in the direction of the heart become weakened. A varicocele is more common on the left because of the specific pattern of blood flow on that side. Varicoceles are linked to infertility in males 20 to 40% of the time. This is because the increased blood flow through the enlarged veins raises the temperature of the testicles and affects the development of sperm.
Most varicoceles do not have symptoms. They are found incidentally during a routine exam or an infertility evaluation. Very large varicoceles may produce a heavy or dragging feeling in the testicles. They rarely are painful.
Approximately 15% of adult men have a small to moderate size left varicocele. Right-sided varicoceles are uncommon. Typically, the presence of a varicocele does not signal any type of serious disease. However, a large varicocele on the right side that appears suddenly may indicate a mass such as an enlarged lymph node or testicular cancer.
There is no known way to prevent developing a varicocele. Routine testicular self- examination may alert the man to any new masses, which should be evaluated by the healthcare professional.
A varicocele is usually diagnosed with a physical exam. It appears as a full but soft mass above the testicle. The mass disappears completely when the man is lying down. The varicocele's appearance has been described as a "bag of worms." Ultrasound is sometimes used to confirm the diagnosis. This is more common during an evaluation for male infertility.
Varicoceles can be linked to male infertility. If abnormalities show up in a semen analysis, repairing the varicocele may improve sperm quality.
There are no risks to others, as a varicocele is not contagious.
A varicocele is usually managed conservatively. A scrotal support may be worn to relieve the heavy sensation in the scrotum, and over-the-counter pain medications may relieve the discomfort. However, if the pain continues or if infertility results from a backup of blood in the veins, surgery may be needed.
Repair of the varicocele is called varicocelectomy. This operation can be accomplished with a variety of incisions. The most common is a small cut in the groin or just below it. Several of the veins draining the contents of the scrotum can be tied off through this opening. An alternative procedure is to make a small incision higher up in the flank. Also, the enlarged veins can be blocked with material injected into them through a catheter, or narrow tube.
Side effects may include bleeding, infection or the accumulation of fluid along the spermatic cord, known as a hydrocele. Rarely, the blood supply to the testicle may be disrupted and testicular death may occur.
The man will feel some discomfort and a sense of congestion in the testicle for a few weeks following the procedure.
If the varicocele makes the scrotum feel uncomfortably full, or impairs fertility, the male should follow up with a healthcare professional. Any new or worsening symptoms should be reported to the healthcare professional as well.
The Merck Manual of Medical Information, Home edition, 1997
Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000