What is a varicocoele?
This condition occurs when there is dilatation (bulging) of the veins around the spermatic cord in men. It is felt as a soft swelling around the cord in the scrotum. Often, this swelling gets worse with prolonged standing, and improves or disappears when lying flat. There can be an associated aching feeling. Varicocoele almost invariably occurs on the left side.
What causes a varicocoele?
The exact cause is not known, but the vast majority of varicocoeles are thought to be due to a weakness in the valves of the veins drain the testicle.
Very rarely, if there is a sudden onset, or the right side is affected, there may be a cause that requires further investigation.
Does the varicocoele need treatment?
Children and adolescents
In children and adolescents, there may be a reason to treat the varicocoele. This needs discussion with your GP and if he/she feels it is necessary, you may be referred to a paediatric urologist.
Men with fertility issues
In adults, there is a link between varicocoele and reduced fertility in some, but not all, people affected. In men with varicocoele and low sperm count/poor semen parameters, there can be an improvement in sperm, which peaks at about 10 months after varicocoele treatment. However, there is no clear evidence that treating the varicocoele has any beneficial effect on pregnancy outcomes.
Men with pain and discomfort
In an adult, varicocoele can be treated is if the swelling is causing problems, such as discomfort and aching.
What treatments are available?
There are different ways to treat a varicocoele. Theses include:
- By interventional radiology. This is done as a day procedure by a radiologist, where the vein is accessed through a small needle puncture in the opposite groin, under local anaesthetic. A wire is passed to the vein, and small coils are dropped into the vein and its branches, to block off the flow of blood.
- By laparoscopic surgery. This is a keyhole operation (general anaesthetic) that can be performed as a day case, but may require an overnight stay, The vein is controlled near to the groin, and small clips are placed on it to block off the blood flow in the vein.
- By microsurgery. Here, a small (2 cm) cut is made below the groin, under general anaesthetic, and the small veins are controlled and tied off as they run from the testis. It is performed with a powerful operating microscope, so that all branches of the vein are controlled. This generally done as a day case procedure.
There are advantages and disadvantages to each procedure. Nick will discuss these options with you, so that you can decide which is best for you.
The things that need to be considered for each procedure are:
- The chance of getting rid of the varicocoele.
- The chance it could reoccur.
- The kinds of complication that can occur with each procedure, and the rate at which they occur.
This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your urologist. The information does not apply to all patients.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.