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Varicocele

Definition

A varicocele is the swelling of the veins inside the scrotum. These veins are found along the cord that holds up a man's testicles (spermatic cord).

Alternative Names

Varicose veins - scrotum

Causes

A varicocele forms when valves inside the veins that run along the spermatic cord prevent blood from flowing properly. Blood backs up, leading to swelling and widening of the veins. (This is similar to varicose veins in the legs).

Most of the time, varicoceles develop slowly. They are more common in men ages 15 to 25 and are most often seen on the left side of the scrotum.

A varicocele in an older man that appears suddenly may be caused by a kidney tumor, which can block blood flow to a vein. The problem is more common on the left side than the right.

Symptoms

Symptoms include:

  • Enlarged, twisted veins in the scrotum
  • Painless testicle lump, scrotal swelling, or bulge in the scrotum
  • Possible problems with fertility or decreased sperm count

Some men do not have symptoms.

Exams and Tests

You will have an exam of your groin area, including the scrotum and testicles. The health care provider may feel a twisted growth along the spermatic cord.

Sometimes 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 or snug underwear may help ease discomfort. You may need other treatment if the pain does not go away or you develop other symptoms.

Surgery to correct a varicocele is called varicocelectomy. For this procedure:

  • You will receive some type of numbing medicine (anesthesia).
  • The urologist will make a cut, most often in the lower abdomen, and tie off the abnormal veins. This directs blood flow in the area to the normal veins. The operation may also be done as a laparoscopic procedure (through small incisions with a camera).
  • You will be able to leave the hospital on the same day as your surgery.
  • You will need to keep an ice pack on the area for the first 24 hours after surgery to reduce swelling.

An alternative to surgery is varicocele embolization. For this procedure:

  • A small hollow tube called a catheter (tube) is placed into a vein in your groin or neck area.
  • The provider moves the tube into the varicocele using x-rays as a guide.
  • 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.
  • You will need to keep an ice pack on the area to reduce swelling and wear a scrotal support for a little while.

This method is also done without an overnight hospital stay. It uses a much smaller cut than surgery, so you will heal faster.

Outlook (Prognosis)

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

If you have surgery, your sperm count will likely increase. However, it will not improve your fertility. In most cases, testicular wasting (atrophy) does not improve unless surgery is done early in adolescence.

Possible Complications

Infertility is a complication of varicocele.

Complications from treatment may include:

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

When to Contact a Medical Professional

Call your provider if you discover a testicle lump or need to treat a diagnosed varicocele.

References

Barak S, Gordon Baker HW. Clinical management of male infertility. In: Jameson JL, De Groot LJ, de Krester DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141.

Barthold JS. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 132.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37:613-626. PMID: 20705202 www.ncbi.nlm.nih.gov/pubmed/20705202.


Review Date: 8/31/2015
Reviewed By: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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