A varicocele is an abnormal swelling of the veins inside the scrotum. Varicoceles are found in about 15% of all men and in about 40% of infertile men. Dilated or swollen veins can cause an elevation of testicular temperature by 1.5⁰ Centigrade. This may not sound like a lot but it is enough to defeat the purpose of the scrotum – a place where testicles are cooler than the rest of a man’s body so that they function well.

Varicoceles are typically more common in men ages 15 – 25 and are most often seen on the left side of the scrotum.

WHAT CAUSES A VARICOCLE TO DEVELOP?

Dr. Robert Pugach advises that a varicocele may form when valves inside the veins that run along the spermatic cord prevent blood from flowing properly. This process is similar to varicose veins that form in the legs. The backups leading to swelling and widening of the veins. Varicoceles develop slowly over time. They are more common on the left side than the right and often are present on both sides.

WHAT ARE THE SYMPTOMS OF A VARICOCELE?

There are 4 things that a varicocele can do:

Nothing – most varicoceles cause no symptoms or problems. If they are small, they cause no noticeable swelling.

Pain – varicoceles can cause mild to significant pain. It is typically not present upon awakening and gets better when lying down. Standing throughout the day allows the pressure in the veins to be transmitted to the scrotum. When the veins dilate they cause irritation and inflammation in the scrotum and around the testicles.

Infertility – an elevation of temperature in the scrotum can negatively affect sperm production. It can cause a decrease in sperm concentration, sperm count, sperm movement and sperm shape. It’s the leading cause of male factor infertility – it is found in 40% of cases

Low Testosterone – elevated testicular temperatures can result in premature or more significant loss of testosterone as men age. It is the one surgically correctable cause of hypogonadism (Low T) in men.

HOW IS A VARICOCELE DIAGNOSED?

Dr. Robert Pugach will conduct an examination of a man’s genital area, including the testicles and scrotum. He is looking for the following conditions:

• Enlarged, twisted veins in the scrotum
• Scrotal swelling or bulging
• Abnormal testicle size (one or both testicles being smaller than normal)
• Abnormal testicle consistency (one or both testicles being softer than normal)

VARIOCELE TREATMENT

If a varicocele causes no significant pain and is not a factor in infertility or Low T, no treatment is necessary. However, if a varicocele is symptomatic or causing problems in any way, surgery to correct the varicocele can be performed.

The operation is called a varicocelectomy. Dr. Pugach performs a varicocelectomy in an outpatient surgical center or hospital. The procedure is performed by making a small opening in the lower abdomen so that the abnormal veins can tied of and blood flow to the dilated veins is stopped. A specialized instrument called a Doppler ultrasound is used to identify and prevent damage to testicular arteries. Recovery is typically fast and most patients can return to normal activities in a few days.

NON-SURGICAL TREATMENT OF A VARIOCELE

An alternative to surgery is varicocele embolization. This is done in the interventional radiology area of a hospital. A catheter is placed in the groin and directed to the dilated veins. Metal coils may be injected that remain in place or concentrated alcohol is injected to cause inflammation and closing of the veins.

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