Varicocele

A varicocele is a swelling of veins in the scrotum (the bag of skin that contains the testicles). It is most common in young men. It occurs most often on the left side. Small or painless varicoceles do not need treatment. Most often, this is not a serious problem, but further tests may be needed to confirm the diagnosis. Surgery may be needed if complications of varicoceles arise. Rarely, varicoceles can reoccur after surgery.

CAUSES

The swelling is due to blood backing up in the vein that leads from the testicle back to the body. Blood backs up because the valves inside the vein are not working properly. Veins normally return blood to the heart. Valves in veins are supposed to be one-way valves. They should not allow blood to flow backwards. If the valves do not work well, blood can pool in a vein and make it swell. The same thing happens with varicose veins in the leg.

SYMPTOMS

A varicocele most often causes no symptoms. When they occur, symptoms include:

  • Swelling on one side of the scrotum.

  • Swelling that is more obvious when standing up.

  • A lumpy feeling in the scrotum.

  • Heaviness on one side of the scrotum.

  • Dull ache in the scrotum, especially after exercise or prolonged standing or sitting.

  • Slower growth or reduced size of the testicle on the side of the varicocele (in young males).

  • Problems with fertility can arise if the testicle does not grow normally.

DIAGNOSIS

Varicocele is usually diagnosed by a physical exam. Sometimes ultrasonography is done.

TREATMENT

Usually, varicoceles need no treatment. They are often routinely monitored on exam by your caregiver to ensure they do not slow the growth of the testicle on that side. Treatment may be needed if:

  • The varicocele is large.

  • There is a lot of pain.

  • The varicocele causes a decrease in the size of the testicle in a growing adolescent.

  • The other testicle is absent or not normal.

  • Varicoceles are found on both sides of the scrotum.

  • There is pain when exercising.

  • There are fertility problems.

There are two types of treatment:

  • Surgery. The surgeon ties off the swollen veins. Surgery may be done with an incision in the skin or through a laparoscope. The surgery is usually done in an outpatient setting. Outpatient means there is no overnight stay in a hospital.

  • Embolization. A small tube is placed in a vein and guided into the swollen veins. X-rays are used to guide the small tube. Tiny metal coils or other blocking items are put through the tube. This blocks swollen veins and the flow of blood. This is usually done in an outpatient setting without the use of general anesthesia.

HOME CARE INSTRUCTIONS

To decrease discomfort:

  • Wear supportive underwear.

  • Use an athletic supporter for sports.

  • Only take over-the-counter or prescription medicines for pain or discomfort as directed by your caregiver.

SEEK MEDICAL CARE IF:

  • Pain is increasing.

  • Swelling does not decrease when lying down.

  • Testicle is smaller.

  • The testicle becomes enlarged, swollen, red, or painful.