A varicocele is a swelling or lump that surrounds the testicle in the scrotum. In 96 percent of all cases, it occurs on the left side. Varicocele is caused by a knot of varicose veins, similar to varicose veins found in the legs, and occurs when the vein that drains the testicle becomes abnormally expanded with pooled blood.

• What are the Symptoms and Signs?
• Who Can Get a Varicocele?
• What is the Cause?
• What is the Risk?
• What is the Treatment?
• Is Surgery Needed?

What are the Symptoms and Signs?

The patient may be aware of a lump, especially when standing, but may notice that the swelling usually disappears when lying down. The degree of discomfort or pain varies considerably from one person to another. There may not be any discomfort; however, some men may experience an uncomfortable dragging pain, especially in hot weather or after exercise. The lump, which may have a bluish appearance through the skin, is soft to feel, like a bunch of grapes or a bag of worms. Tests are not usually necessary, but an ultrasound may be ordered if there is any doubt about the diagnosis.


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Who Can Get a Varicocele?

A varicocele is generally first noticed in males between puberty and 35 years of age, especially near the end of adolescence. Any male can be affected, although it is seen more frequently in tall, thin men, especially those from hot climates. Varicoceles are common and found in about 8 percent of the adult male population.


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What is the Cause?

The cause is a mechanical problem in the drainage of the testicular vein into the renal vein of the kidney. A faulty valve in the testicular vein leads to back pressure in the system and thus swollen varicose veins around the testicle. There is not a known reason why only certain men experience the condition; however, there is a tendency for varicoceles to run in families.

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What is the Risk?

A primary varicocele is a relatively minor condition without serious consequences. However, in some men the discomfort is such that surgical treatment is required while others can live with a very mild discomfort. Varicoceles are thought to be associated with decreased fertility, although this has not been scientifically proven.


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What is the Treatment?

If the varicocele is not causing the patient discomfort, treatment is not necessary. For mild discomfort and swelling, the patient can wear firm-fitting underpants or a jockstrap. (Keep in mind that the discomfort and swelling tends to disappear when lying down.)


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Is Surgery Needed?

Surgery may be recommended if the varicocele is causing significant discomfort, or associated with a reduced size of the left testicle or infertility. The operation is a straightforward but delicate procedure in which the vein draining the varicose veins is ligated, or tied off. This causes the veins to collapse without affecting the testicle’s function. Results from surgery are very good, with an 80 percent success rate.


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