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Varicocoele

A varicocoele is an abnormal enlargement of veins inside a man’s scrotum caused by the backflow of blood. This is similar to the process that causes varicose veins in the legs.

A varicocoele (pronounced var-uh-ko-seel, and sometimes spelled varicocele) is usually harmless, sometimes with few or no symptoms. However, varicocoeles can cause gradual damage and impair function of the testicles and potentially cause male infertility due to a reduction in the quality and number of sperm produced by the testicles. 

It is estimated that 15–20% of men or teens will have a varicocoele but in men with fertility problems this increases to 40%. 

Symptoms

The veins in your scrotum carry blood away from the testicles towards the heart – small valves within the veins normally prevent blood flowing in the other direction. However, if these valves do not work properly, some blood can back-up increasing pressure and causing veins to enlarge, creating a varicocoele.
 
Varicocoeles almost always affect the left scrotum and most commonly occur in men between the ages of 15 and 25 years. The reason varicocoeles develop is not fully understood. They usually develop slowly and may produce no symptoms. If symptoms do occur, they may include:
 
  • A dull aching or throbbing pain (or in rare cases sharp and stabbing pain) in one or both testicles
  • A dragging or heavy feeling in the scrotum
  • Swelling in the scrotum (this is often described as feeling like "a bag of worms")
  • The testicle on the side of the swelling is often smaller, due to alterations in blood flow.
Symptoms may be more noticeable after exercise, standing for long periods, or during hot weather. Symptoms may reduce, or disappear altogether, when lying down.

Diagnosis

In order to make an accurate diagnosis the doctor will take a medical history and will examine the scrotum. In order to confirm the diagnosis an ultrasound scan of the scrotum may be recommended. 

The majority of varicocoeles are small and do not produce symptoms. In these cases, treatment is not usually required. However, treatment may be recommended if the varicocoele: 
 
  • Produces unpleasant symptoms
  • Looks particularly unsightly
  • Affects fertility
  • Impairs the growth of the testicle (this is a particular concern for adolescents).

Treatment 

Anti-inflammatory medications may be recommended if a varicocoele causes pain and swelling. The wearing of snug, supportive underpants or an athletic supporter may also be suggested.

A procedure to repair the varicocoele will be considered if the condition is causing testicular pain, or is considered likely to cause testicular damage. Otherwise, watchful management is an option with yearly check-ups and re-evaluation of the affected testicle .

Surgical treatment involves tying off (ligating) an affected vein so that blood is redirected into other, healthy veins. The procedure is likely to be done using a minimally invasive (laparoscopic) surgical method that involves several small incisions and the use of a small camera to enable the surgeon to see inside your body.  Alternatively, the surgery can be done using one larger incision through which the surgeon views the problem area without need of a camera. Both methods have similar success rates but laparoscopic surgery tends to have a quicker recovery time. Both types of surgery are performed on a day-stay basis under a general anaesthetic. 

Another treatment method is varicocoele embolisation. This non-surgical technique involves making a small incision in a vein in the groin or neck and guiding a thin tube (catheter) into the varicocoele with the help of x-ray pictures. A small metal coil is threaded through the tube and released into the affected vein. The coil blocks blood flow to the bad vein and redirects it to other, healthy veins. 

Sometimes a special solution that causes scarring (a sclerosing solution) is used to block off the affected vein instead of a coil. Varicocoele embolisation has a quick recovery time and has the advantage of not requiring a general anaesthetic. 

References

TeensHealth (2017). Varicocele (Web Page). Jacksonville, FL: Nemours Foundation. http://kidshealth.org/en/teens/varicocele.html# [Accessed: 30/03/20] 
Mayo Clinic (2020). Varicocele (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/varicocele/symptoms-causes/syc-20378771 [Accessed: 30/03/20] 
White, W.M. (2019). Varicocele (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/438591-overview [Accessed: 30/03/20]
O'Toole, M.T. (Ed.) (2017). Varicocele. Mosby's Dictionary of Medicine, Nursing & Health Professionals. (10th ed.) St. Louis, MI: Elsevier.
 
Last Reviewed – March 2020
 
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