Male Varicocele – Infertility & Testicular Pain
Varicoceles are enlarged varicose veins that occur in the scrotum. They are more common on the left and they frequently arise because of abnormal drainage, whereby the draining blood stagnates or reverses direction within the veins draining the testes. Varicoceles are common and affect 15 out of 100 men overall and 40 out of 100 men who show signs of infertility.
Usually varicoceles produce no signs or symptoms, but may cause infertility through decreased sperm counts/function. On rare occasions it may cause pain. A patient may experience:
- Sharp to dull discomfort
- Pain that increases with standing or physical activity, especially over long periods of time
- Pain that worsens over the course of a day
Varicoceles often require no treatment and may only be discovered during a fertility evaluation or a routine physical exam.
Surgical and non-surgical treatments are available and are performed to reduce the pain associated with the condition and possibly improve fertility. Surgical intervention is performed with an incision made in the pelvis adjacent to where the testes originally descend. The doctor identifies the pathologic veins and ligates them to eliminate blood flow to the varicocele.
As an alternative to surgery, a catheter based, endovascular procedure called embolization can be performed. A varicocele embolization is performed through a catheter advanced into the femoral vein located in the groin. Using real-time x-ray, the small catheter is steered into the small veins draining the varicocele and the vein is then occluded, typically using special plugs/coils and a sclerosant. By eliminating blood flow in the pathologic veins, the patient’s symptoms are typically ameliorated. The embolization is performed as an outpatient with local anesthesia and conscious sedation. There are no incisions and hence, no sutures required with this procedure.
Patients typically are sent home within hours after a varicocele embolization. The patient is prescribed with pain medication if needed. Light work duties can be resumed the following day and full laborious activities within one week of the procedure.