What is a varicocele?

A varicocele is formed by a varicose vein (an unusually swollen vein) or a group of varicose veins, located in the scrotum or in the spermatic cord.

Varicoceles usually develop during puberty, growing larger and more noticeable with time. They occur most often on the left side of the scrotum, and although not usually harmful, in some people it can cause pain in the testicles, cause one testicle to grow slower than the other, and/or affect the patient’s fertility.

There is also a female varicocele, which involves an enlargement of the ovarian veins and causes pelvic varicose veins.

Varicocele can cause severe pain that becomes worse throughout the day.

Prognosis of the disease

Varicocele is not a serious disease, but it is a common cause of low sperm production and therefore can cause infertility. In some cases the varicocele can cause the testicles to shrink (atrophy) and not develop normally.


Symptoms of a varicocele

Usually a varicocele is asymptomatic, but in some cases it can cause pain that varies from mild discomfort to acute pain. This pain may increase throughout the day. It may also be exacerbated by standing up or upon physical exertion.

Over the years, the varicocele grows and becomes more evident. The testicle may appear swollen.

Varicoceles are also known to cause infertility in some patients, making it more difficult to father a child.


Medical tests for varicocele

The diagnosis of a varicocele is made by an urologist or andrologist, who carries out a physical examination in search of a firm lump in the testicle, a characteristic of a varicocele. If the examination is inconclusive, a scrotal ultrasound may be required.


What are the causes of a varicocele?

A varicocele is the enlargement of a vein within the spermatic cord (which contains the vas deferens and blood vessels that provide the testicles with their blood supply). There are several theories as to why this happens, but the cause is uncertain.


Treatments for a varicocele

In many cases a varicocele does not need treatment as long as it does not cause symptoms or affect fertility.

If a testicular varicocele produces symptoms of pain and/or causes infertility, there are surgical options. The varicocele can be removed via a varicocelectomy, which involves removing the affected veins and redirecting blood flow through healthy veins. It is done on an outpatient basis and under general anesthesia, being able to return to your regular daily activities a few days later. The pain should subside within a few days or weeks.

An alternative to surgery is percutaneous embolisation of the varicocele, where a much smaller incision is performed and involves placing a catheter inside the vein.


Which specialist treats a varicocele?

Urologists specialise in treating the urinary system and male reproductive system, while andrologists are further specialised in the diagnosis and treatment of the pathologies of the male sex organs, including the testicles. In cases of varicocele in puberty, it is possible that a paediatrician notices the presence of a varicocele, since in many cases it develops at this point in the patient’s life.

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