The veins surrounding the testicles expand and result in an increased temperature which is believed to negatively affect sperm production. Surgery may be required to correct the condition.
Men who have varicocele are not infertile but 1/3 of infertile men have varicocele.
Normally varicocele is seen in 15% of the general population whereas 40% of infertile men have varicocele. The doctor will examine the patient both in an upright position and while the patient is lying down. Palpation done when the patient standing will feel like a sack of worms but this feeling will decrease or disappear when the patient is lying down.
Varicocele can only be treated surgically.
Indications for varicocele surgery:
If sperm parameters are normal then surgery is performed if it causes discomfort or for cosmetic reasons (if it is large).
Young men should have yearly examinations even if their sperm parameters are normal to monitor any changes and operate before the problem progresses.
When children are diagnosed with varicocele:
- If there is asymmetry in testicular size,
- Abnormal semen results accompanying clinical findings,
- If the child complains of swelling, feeling of heaviness or testicular pain,
Or if varicocele affects both sides then it should be operated on.
When the male partner is infertile then his female partner’s age gains importance. If the woman’s age is close to 40 then the couple may not have time to wait for the results of varicocele surgery. If the varicocele is not painful, artificial reproductive technology might be a quicker solution.
Young infertile patients may also benefit from varicocele surgery.
If the female partner is also infertile then the couple will need treatment for infertility which obviates the need for varicocele surgery except for cosmetic reasons.
Some of the possible complications of varicocele correction surgery are: infection, hydrocele, varicocele persistance and recurrance.
Semen analysis must be done every three months after varicocele correction surgery for one full year minimum or until the couple achieves pregnancy.
There are a varieties of procedures for varicocele treatment. Retroperitoneal, inguinal (an incision is made in the groin area), microsurgical, making sub inguinal cut near the scrotum, laparoscopic ligation or blocking the veins with radiation (embolization) are some of the methods. The ultimate goal is to perform the treatment that best fits varicocele type and has the least chance of reccurrence. Ligating veins near the scrotum with the aid of a microscope (microsurgical varicocelectomy) appears to be the most successfull treatment. This method also has less post operative pain.
|Surgical Technique||Incidence of hydrocoele||Recurrence||Cost|
|Retroperitoneal||%7-10||%9-11 (artery preserved)|
< %3 (artery not preserved)
|Inguinal Microscopic||< %1||%0,6-2.1||Modarete|
%1.25 in young patients