How is a varicocele diagnosed?
The diagnosis is made by a doctor's examination. A colour duplex ultrasound scan (a scan using ultrasound to look at blood flow in an area) is sometimes done to confirm the diagnosis. A varicocele is associated with some cases of infertility. Therefore, a semen test may be asked for if you are part of a couple being investigated for infertility. In the rare situation of a varicocele first developing in a man aged over 40, tests to check out a possible underlying cause may be advised. Also, a solitary right-sided varicocele is unusual. If this occurs, you may need some tests to rule out any unusual cause.
When does a varicocele need treating?
If a varicocele is causing no symptoms or problems, then it is best left alone. It is usually harmless but there are some situations in which it can cause concern.
When can a varicocele cause concern?
Possible cause of infertility
Studies have shown that there is a higher rate of infertility in men with a varicocele compared with those who do not have a varicocele. The reason for this is not clear. One theory is that the pooled blood causes a slightly higher temperature in the scrotum than normal. This may reduce the number and quality of sperm made by the testicle (testis), which can reduce fertility. Even if you have a varicocele only on one side, both testicles (testes) can be warmed by the increased amount of blood pooled in the enlarged veins (blood vessels).
Research has shown that 25 in 100 men with problems showing up on sperm analysis have a varicocele and that treating the varicocele usually improves sperm quality. And remember, most men with a varicocele are not infertile.
Currently it's recommended that a varicocele should be treated if:
- It's obvious on examination (as opposed to just showing up on a scan).
- Sperm count is low; you've been infertile for two years or more.
- Your infertility is otherwise unexplained.
If a large varicocele develops in a teenager, the testis on the side of the varicocele may not develop as much as would be expected. For example, an annual measurement of the testes may be advised. The testis may end up being smaller than normal. This may contribute to infertility too.
Sudden onset of a varicocele in an older man
Very rarely, a varicocele quickly develops as a symptom of a blockage of a larger vein in the tummy (abdomen) - see above. This would normally only occur in men over the age of 40.
What treatments are available?
If there is just mild discomfort, supportive underpants (rather than boxer shorts) may help to ease or prevent discomfort.
Treatment involves tying off the veins (blood vessels) that are enlarged. Another method of treatment is to use a special substance injected into the veins to block them. Both methods are usually successful. Your surgeon will advise on the pros and cons of the different techniques.
However, after successful treatment, some men have a return (recurrence) of a varicocele months or years later. This is because the veins left behind to do the job of taking the blood from the testes may themselves enlarge (dilate) with the extra blood they will now have to carry. A recurrence can be treated in the same way as the first time.
Further reading and references
Guidelines on Male Infertility; European Association of Urology (2015)
D'Andrea S, Micillo A, Barbonetti A, et al; Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men. J Endocrinol Invest. 2017 May 25. doi: 10.1007/s40618-017-0695-x.
Kolon TF; Evaluation and Management of the Adolescent Varicocele. J Urol. 2015 Nov194(5):1194-201. doi: 10.1016/j.juro.2015.06.079. Epub 2015 Jun 25.
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