Varicocele

(Varicose Veins—Scrotum)

Definition

A varicocele is swelling in the scrotum associated with the backup of blood in the testicular vein.

Varicocele

testicle varices
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Causes    TOP

A varicocele is caused by a problem in the main vein of the testicle. Blood normally leaves the testicle through the spermatic vein. When this vein is not working properly, the blood gets backed up and the veins bulge.

Risk Factors    TOP

Varicoceles typically develop in men 15-25 years old. There are no specific factors that increase your risk of getting varicoceles.

Symptoms    TOP

Varicoceles may not always have symptoms. When they do appear, symptoms may include:

  • Feeling of heaviness or soreness in the scrotum.
  • Feeling enlarged, or twisted veins in the scrotum. They can feel like worms or spaghetti.
  • Veins typically change in size and are larger when standing or straining.

Varicoceles may cause the testicle to be smaller. It may also contribute to male infertility by reducing sperm quality and/or quantity.

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. Varicoceles are usually easily diagnosed by exam. Your doctor may recommend tests to confirm varicoceles or rule out other conditions.

Tests may include:

  • Ultrasound
  • Semen tests
  • Blood tests to look for testicular injury in adolescents

Treatment    TOP

Talk with your doctor about the best treatment plan for you. Treatment is not required for all varicoceles. Treatment is generally recommended if a varicocele is causing infertility, change in testicle size, or if it is causing pain.

Options may include one or more of the following:

Home Care

To help ease discomfort, your doctor may recommend over-the-counter pain relievers. In some cases, you may need to wear supportive or athletic underwear.

Surgery

Surgical treatment options include:

  • Open surgery—the veins are surgically cut and tied off through an incision in the groin
  • Catheter ablation—heat is applied through a catheter to destroy the vein
  • Catheter embolization—a substance is placed in the vein(s) to block it
  • Laparoscopic varicocelectomy—involves the use of a thin, lighted tube inserted into the abdomen to view the vessels in the body as they lead to the testicle and block them

Prevention    TOP

There are no current guidelines to prevent varicoceles.

RESOURCES:

Reproductive Facts—American Society for Reproductive Medicine
http://www.reproductivefacts.org
Urology Care Foundation
http://urologyhealth.org

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Khera M, Lipshultz LI. Evolving approach to the varicocele. Urol Clin North Am. 2008;35(2):183-189.
Painless scrotal mass. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/genitourinary-disorders/symptoms-of-genitourinary-disorders/painless-scrotal-mass. Updated March 2017. Accessed March 8, 2018.
Robinson SP, Hampton LJ, Koo HP. Treatment strategy for the adolescent varicocele. Urol Clin North Am. 2010;37(2):269-278.
Practice Committee of the American Society for Reproductive Medicine. Report on vericocele and infertility: A committee opinion. Fertil Steril. 2014;102(6):1556-1560.
Varicocele in adults. EBSCO DynaMed Plus website. Available at:http://www.dynamed.... Updated January 29, 2016. Accessed March 8, 2018.
Varicocele. Kids Health—Nemours Foundation website. Available at:
...(Click grey area to select URL)
Updated February 2017. Accessed March 8, 2018.
Varicoceles. Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Accessed March 8, 2018.
Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37(3):613-629.
Last reviewed March 2018 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 1/1/2014

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