Alternate Names: Varicose veins within the scrotum

Causes and Risks: Varicocele is caused by incompetent or inadequate valves within the veins along the spermatic cord (the cord suspending the testis). The abnormal valves obstruct normal blood flow causing a backup of blood, resulting in dilation (enlargement) of the veins. Varicoceles usually develop slowly and may be asymptomatic. The incidence is higher in men between 15 and 25 years old.

Varicoceles have been found to be the cause of infertility in 39% of the males who were treated for infertility.

The sudden appearance of a varicocele in an older man may be caused by a renal tumor that has affected the renal vein and altered the blood flow through the spermatic vein.

Symptoms:

• Visible and enlarged twisting (tortuous) veins in the scrotum
• Infertility
• A painless testicle lump, scrotal swelling, or bulge within the scrotum, more common on the left side

Signs and Tests: A non-tender, tortuous mass is noted along the spermatic cord (feels like a bag of worms). The mass may not be palpable (able to be felt) or obvious if patient is lying down. The testis on the side of the varicocele may or may not be atrophied (smaller) when compaired to the other side.

Treatment: Varicoceles may be managed conservatively with the use of a scrotal support. However, if pain continues despite conservative treatment, or if infertility or testicular atrophy results, a surgical ligation (tying off) of the varicocele may be required.

SURGERY:
Varicocelectomy, or the surgical correction of a varicocele is performed on an outpatient basis. The incision is usually made just above the scrotum. Ice packs should be kept to the area for the first 24 hours after surgery to reduce swelling. You will be advised to wear a scrotal support for some time after surgery.

Possible complications of this procedure include hematoma (blood clot formation), infection, or injury to the scrotal tissue or structures.

Prognosis: A varicocele is usually harmless and requires no treatment. If surgery is required because of infertility or testicular atrophy, an excellent outcome can usually be achieved.

Complications: Infertility or testicular atrophy (shrinkage) may develop as a result of a varicocele.

Call for an appointment with your health care provider if treatment of a varicocele is desired, or if an undiagnosed testicle lump is present.