Varicoceles are abnormally enlarged veins in the scrotum. Most veins contain valves that prevent blood from flowing back away from the heart. In varicocele there is failure of the valves resulting in blood pooling in the veins in the scrotum causing them to dilate and sometimes causing negative symptoms.

Varicoceles can cause 3 main problems. These are:

-Pain or discomfort in the scrotum

-Reduced fertility

-Reduced testosterone

While most varicoceles usually do not cause any symptoms, treatment would be considered in the setting of the above signs and symptoms. The larger the varicocele the more likely it is to cause problems.

Up to 20% of men with varicoceles can have fertility problems. There is strong evidence to suggest that repairing a varicocele improves testicular function and may prevent any further testicular damage over time. If there is evidence of damage to the testicle, varicocele repair might be important to improve testicular function and/or prevent further decline.

Most varicoceles have an effect on testosterone production however this may still lie in the normal range. A blood test can help to see if your testosterone level is below the normal range. Almost all men who undergo repair of their varicocele see a rise in their testosterone levels – however this does not mean all varicoceles should be treated. Additionally atrophy (shrinkage) of the testicle on the affected side can occur. Pain due to varicocele is often worse at the end of the day or after exercise

You may feel a lump in your scrotum, often described as a bag of worms. There may be pain in the scrotum, usually at the end of the day or after exercise. An ultrasound is required to make the diagnosis, usually organised by your GP who will also evaluate your condition. A trained ultrasound technician will assess the veins in your scrotum by asking you to strain to see if the veins are enlarged.

EMBOLISATION

(Minimally Invasive Repair - Non-surgical)

he modern mainstay of treatment is called embolisation. This is a surgery-free minimally invasive treatment performed at Emboflow. A very thin (2mm) plastic tube is inserted into a vein in the neck and navigated to the gonadal vein that is causing the varicocele. Once in position, a combination of small metal coils and vein foam (see diagram) are used to block the offending gonadal vein. This results in the varicocele shrinking away. This can be very comfortably performed with just local anaesthetic under the skin in the neck and some light sedation similar to what you might get at the dentist. The procedure is a day-procedure meaning you can go home the same day and resume normal activities the next day. The success rate is very high with only a small chance of recurrence, and the complication rate is very low.

SURGERY

In general, the surgical options require general anaesthetic (see risks of anaesthetic) and are a more major procedure. There are two main surgical options;

1. Laparoscopic repair

A camera and instruments are inserted through the abdomen. The gonadal vein is then identified and metal clips are used to close the vein. This has a lower success rate than embolisation or open surgery, has a higher rate of secondary hydrocele (fluid collecting in the scrotum), and although complications are rare when they do occur can be more severe with this approach.

2. Open repair

An subinguinal incision is made where the gonadal vein and varicocele is identified and tied off. The results are similar to minimally invasive surgery-free repair however there is usually a longer recovery time with open repair.

Note that minimally invasive repair has largely replaced surgical repair of varicocele.

CONSERVATIVE MANAGEMENT

For those who do not wish to have their varicocele repaired then measures such as rest, anti-inflammatory medication, and supportive underwear may provide some relief however this does not fix the underlying problem and the varicocele is likely to continue to cause symptoms and may even get worse.