Symptoms

A varicocele often produces no signs or symptoms. Rarely, it might cause pain. The pain may:

• Vary from sharp to dull discomfort
• Increase with standing or physical exertion, especially over long periods
• Worsen over the course of a day
• Be relieved when you lie on your back
• Impaired fertility

Treatment

Often, varicoceles are not treated. Treatment is offered for males who have:

• Fertility problems (problems fathering a child)
• Pain
• The left testicle growing more slowly than the right
• Abnormal semen analysis

There are no drugs to treat or prevent varicoceles. But pain killers (such as acetaminophen or ibuprofen) may help with pain.

When needed, surgery is the main form of treatment. Embolization (briefly blocking the veins) is a non-surgical treatment option.

Surgery

There are many ways to do varicocele surgery. All involve blocking the blood flow in the pampiniform plexus veins.

Surgery is done under general anesthesia. The two most common surgeries are:

• Microscopic varicocelectomy: With this technique, the surgeon makes a 1 cm cut above the scrotum. Using the microscope, the surgeon ties off all small veins, but avoids the vas deferens, testicular artery and lymphatic drainage. The procedure takes 2 to 3 hours, and the patient goes home on the same day.
• Laparoscopic varicocelectomy: With this technique, the surgeon inserts thin tubes in the abdomen and performs vein ligation. This procedure is shorter and takes about 30-40 minutes. Patient returns home on the same day.

Surgery Results

Since surgeons have started using smaller cuts through the muscle for open surgery, healing time and pain are about the same with microscopic and laparoscopic surgery. Problems after either surgery are rare. Some problems could include:

• Varicocele remaining (persistence) or coming back (recurrence)
• Fluid forming around the testicle (hydrocele)
• Injury to the testicular artery

There is a small chance surgery won’t fix the problem. In rare cases, injury to the testicular artery can lead to loss of the testicle. Persistence or recurrence of the varicocele happens in less than one of ten patients who have surgery. Microscopic surgery has the lowest persistence rate or chance of varicocele coming back.

Most of the time, patients return to normal activities after one week with little pain.