Varicocele

(Varicose Veins—Scrotum)

Definition

A varicocele is swelling in the scrotum due to a back up of blood in the main veins of the testicles.Not all varicoceles require treatment. Varicoceles that interfere with fertility, cause pain, or cause other problems may require surgery.
Varicocele
testicle varices
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Causes

A varicocele is caused by a problem in the main vein of the testicle. Blood normally leaves the testicle through the spermatic vein. When this vein is not working properly, the blood gets backed up and the veins bulge.

Risk Factors

Varicoceles typically develop in men 15-25 years old. There are no specific factors that increase your risk of getting varicoceles.

Symptoms

Varicoceles may not always have symptoms. When they do appear, symptoms may include:
  • Feeling of heaviness or soreness in the scrotum.
  • Feeling enlarged, or twisted veins in the scrotum. They can feel like worms or spaghetti.
  • Veins typically change in size, and are larger when standing or straining.
Varicoceles may cause the testicle to be smaller. It may also contribute to male infertility by reducing sperm quality and/or quantity.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Varicoceles are usually easily diagnosed by exam. Your doctor may recommend tests to confirm varicoceles or rule out other conditions.Tests may include:
  • Ultrasound
  • Semen tests
  • Blood tests to look for testicular injury in adolescents

Treatment

Talk with your doctor about the best treatment plan for you. Treatment is not required for all varicoceles. Treatment is generally recommended if a varicocele is causing infertility, change in testicle size, or if it is causing pain.Options may include one or more of the following:

Home Care

To help ease discomfort, your doctor may recommend over-the-counter pain relievers. In some cases, you may need to wear supportive underwear or a jock strap.

Surgery

Surgical treatment options include:
  • Open surgery—the vein is surgically cut and tied off
  • Catheter ablation—heat is applied through a catheter to destroy the vein
  • Catheter embolization—a substance is placed in the vein to block it
  • Laparoscopy —involves the use of a thin, lighted tube inserted into the abdomen to view the vessels in the body as they lead to the testicle

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Prevention

There are no current guidelines to prevent varicoceles.

RESOURCES

Reproductive Facts—American Society for Reproductive Medicine
http://www.reproductivefacts.org

Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

References

Khera M, Lipshultz LI. Evolving approach to the varicocele. Urol Clin North Am. 2008;35(2):183-189.

Painless scrotal mass. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/genitourinary%5Fdisorders/symptoms%5Fof%5Fgenitourinary%5Fdisorders/painless%5Fscrotal%5Fmass.html. Updated February 2012. Accessed May 29, 2013.

Robinson SP, Hampton LJ, Koo HP. Treatment strategy for the adolescent varicocele. Urol Clin North Am. 2010;37(2):269-278.

Practice Committee of the American Society for Reproductive Medicine. Report on vericocele and infertility: A committee opinion. Fertil Steril. 2014;102(6):1556-1560.

Varicocele. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 10, 2013. Accessed May 29, 2013.

Varicocele. Nemours Kid's Health website. Available at: http://kidshealth.org/teen/sexual%5Fhealth/guys/varicocele.html. Updated May 2011. Accessed May 29, 2013.

Varicoceles. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=116. Updated January 2011. Accessed May 29, 2013.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37(3):613-629.

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