Facts on Varicoceles

A varicocele is a dilatation of the veins that drain the testicle. It is most often found as a solitary left-sided lesion (80% to 90%), but a varicocele may be bilateral (in up to 20% of patients) or right-sided alone (2%). Approximately 10-15% of the general male population have a varicocele, however, among infertile males, the incidence is three times higher. The cause of this abnormality is in part related to the specific and unique venous drainage of the testis - the left spermatic vein is 8-10 cm. longer than the right one, and lacks valves near its insertion into the left kidney vein. The greater hydrostatic pressure in the left drainage system predisposes to left-sided varicocele formation.

On clinical examination, the testis associated with a varicocele may be significantly smaller than its counterpart. Testicular size can be assessed and followed quite accurately with ultrasound. In addition, the semen analysis can demonstrate a "stress pattern" - decreased sperm count, impaired motility, and more abnormal sperm forms. Abnormal testicular function in varicocele patients is thought to be related to elevated testicular temperature, which is normally 1°C cooler than body temperature.

Not all patients with varicoceles require surgical correction. Varicocele repair should be considered in the patient complaining of scrotal pain increasing after exercise or standing, or the patient with impaired testicular function, or the patient who has diminished testicular size. The latter indication for surgery is extremely important in the adolescent male. Studies have shown that varicocele surgery in this age group can result in an improvement in testicular size, which may in turn, protect against the possible development of infertility.

Surgical correction of a varicocele is performed on an outpatient basis under either local or general anesthesia. The incision is made in the inguinal region, similar to a hernia repair, and the dilated veins are isolated and ligated with sutures. A varicocele can also be repaired through laparoscopy. Although the flow of venous blood is immediately arrested, it may take several weeks to months for the scrotal varicocele to diminish in size. A scrotal support (jock strap) will reduce the postoperative discomfort and should be brought with you on the day of surgery. Results of varicocele repair vary - 50% to 90% of patients show some improvement in semen quality, and 30% to 50% may initiate pregnancies within six to nine months after surgery.

urologychannel has more information on varicoceles.

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