A varicocele is an enlargement of the veins within the scrotum. The scrotum is the pouch (sac) of skin that holds the testicles. About 15% of males develop a varicocele. Varicoceles are thus equivalent to varicose veins of the scrotum/ testicle.
The veins within the scrotum, called the pampiniform plexus, helps drain blood from the testicle and keeps the scrotum cool. This cool temperature is ideal to help make sperm which aids fertility.
Varicoceles often form during puberty and teenage years and increase in size over time. It is far more common on the left side of the body, although it can occur on both sides. In the majority of individuals varicoceles are harmless. In some individuals however, varicoceles can cause pain, the testicle to shrink, and in about 20% there may be infertility issues.
The cause of varicoceles of the testicle is variable but the most frequent cause is sluggish and refluxing blood flow within the testicle vein which causes the veins to swell under the increased pressure with the vein. If the scrotum suddenly swells then the patient should seek medical attention. Varicoceles are diagnosed by a combination of clinical examination, ultrasound of the testicle and MRI of the testicle veins from its origin. In this way the size of the veins and the extent of the veins can be determined. Treatment of Varicoceles/ Varicose veins of the Scrotum Varicoceles may be left alone if they are harmless or not giving any symptoms. If there are fertility issues, if there is pain then treatment may be indicated.
The main advantage of the ‘keyhole” option is that the source of the varicocele/ varicose vein is dealt with. This is done by sealing up the swollen veins by micro-coils. It is a highly and very effective way of dealing with varicoceles although coil migration to a non-target source is a rare complication. By embolizing the swollen veins the varicocele shrinks. It is done under local anaesthetic, There are no cuts required, and it is relatively painless. A pre-operative MRI helps to decide whether this treatment would be effective.
The second option is surgery although this is associated with local wound and sororal issues, and the risk of damage to the main artery to the testicle. It also requires the need for general anaesthesia. At the Varicose vein centre we offer coil embolization as a treatment for varicoceles. If a surgical option is required then referral to a Urologist will be required.
Post treatment with coil embolization vigorous exercise should be avoided for 10 days but return to work can be immediate. With surgery, return to work can be 2-7 days once again avoiding exercise for 2 weeks.