Varicocele
Treatment for enlarged veins around the testicle when associated with pain, testicular changes or fertility concerns
What is varicocele?
A varicocele is a set of dilated veins in the cord above the testis, caused by valves that no longer stop blood flowing backwards. Around fifteen in every hundred men have one, and it usually appears during adolescence.
It is far commoner on the left, because the left testicular vein joins the renal vein at a right angle and drains against a longer column of blood. One appearing on the right alone, or one that does not empty when you lie down, is investigated for a cause higher up in the abdomen.
The pooled blood raises the temperature around the testis and exposes it to substances that should have been carried away. That mechanism is behind the two findings that make a varicocele worth treating: a testis growing less than its partner in a teenager, and semen quality falling in a man trying to conceive.
What you might notice
- Soft swellings in the scrotum that empty when you lie down
- A dragging ache in the scrotum
- A semen report with values out of range
How it is diagnosed
A varicocele is found by examining you standing, first at rest and then while you bear down, and it is graded by whether it can be seen, felt easily, or felt only with that manoeuvre. Lying down should empty it.
A scrotal Doppler ultrasound confirms the diameter of the veins, measures the reflux, and compares the volume of the two testes, which is the number that matters most in an adolescent.
Where fertility is the reason for the visit, two semen analyses several weeks apart are what decide whether anything needs doing, alongside hormone levels. A varicocele that does not drain on lying flat prompts a scan of the abdomen.
Recovery
Treatment is day-case work whichever route is used. Expect an ache and some scrotal swelling for about a week, and support and ice help through it.
Desk work resumes within two to four days after a groin or keyhole approach, and the same day or the next after a catheter-based one. Sport and heavy lifting wait two to three weeks.
Semen takes time to reflect the change, because a full production cycle is about three months. A repeat analysis at three and six months is how the result is judged, and any improvement is gradual across that period.
If it is left untreated
Most varicoceles never need anything. A man with one found incidentally, normal testicular volumes on both sides and no plans for a pregnancy can be left alone, and that is the commonest outcome.
What needs watching is a teenager whose affected testis is measurably smaller than the other, since that growth can be lost and does not always come back, and a man whose semen parameters are falling on serial testing.
A varicocele that appears suddenly in an older man, or one that stays full when he lies flat, is investigated rather promptly for a mass obstructing the vein higher up, and that is a scan and not a period of watching.
Questions about varicocele
Does a varicocele always need treating?
No, and most do not. A varicocele found incidentally in a man with normal testicular volumes, normal semen parameters and no discomfort can be left alone indefinitely. Treatment is offered for three reasons: an adolescent whose affected testis is measurably smaller than the other side, a man with abnormal semen parameters and a palpable varicocele while the couple is trying to conceive, and persistent aching that interferes with daily life. Outside those, watching it with an occasional examination is the standard approach.
Will treating it improve my sperm count?
It can, and the men most likely to benefit are those with a varicocele that can be felt easily on examination alongside abnormal parameters, and less so one visible only on a scan. Any change is gradual, because a sperm production cycle takes about seventy-four days, so semen is retested at three and six months and not before. Microsurgical varicocelectomy is the approach with the lowest recurrence because the artery and lymphatics are identified and spared under the microscope. Improvement is not guaranteed for anyone, and that is discussed before the decision.
Why is it almost always on the left?
Anatomy. The left testicular vein joins the left renal vein at a right angle and drains upwards against a taller column of blood, while the right one enters the vena cava obliquely at a lower pressure. That is why roughly nine in ten varicoceles are left-sided or bilateral with a dominant left side. A varicocele on the right alone, or one that stays full when you lie down, is the exception and prompts a scan of the abdomen to exclude something obstructing the vein higher up.
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Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one