Testicular Varicocele – What Is It and How Is It Treated?

Varicocele, similar to varicose veins in the leg, is a relatively common condition that involves an enlargement of the veins within the scrotum. Most commonly affecting younger men (ages 15-35), varicocele can cause pain, shrinkage of the testicles (testicular atrophy), and infertility.

Although the cause is uncertain, many experts believe that the condition occurs when valves within the vein malfunction, causing blood to pool and enlarge the vein, similar to the cause of varicose veins in the legs.

Most cases develop gradually, are easy to diagnose, and do not require treatment. Varicocele that causes symptoms, however, can be treated surgically or nonsurgically.

Symptoms

Approximately 10 percent of all men have varicocele, but most of those affected do not experience symptoms. For those who do, the most common are:

• Dull, aching pain in the scrotum, particularly when standing;
• Testicular atrophy;
• Decreased fertility.

Diagnosis
In most cases, varicocele is reliably detected and diagnosed through a physical examination of the scrotum and an evaluation of the symptoms. When further evaluation is necessary, abnormal blood flow can often be detected with ultrasound imaging or through magnetic resonance venography.

Treatments

There are two main treatment options for varicocele:

• Varicocele embolization

Varicocele embolization (also called catheter-directed embolization) is an image-guided, nonsurgical treatment performed by an interventional radiologist. The Brigham and Women’s Hospital Vascular and Vein Care Centers feature one of the most experienced groups in the region performing this noninvasive procedure.

Embolization patients should be able to return home on the same day of the procedure and return to normal activities within 24 hours. Advantages of embolization include:

• Shorter recovery time as compared to surgery;
• No hospital admittance;
• No surgical incision, just a tiny insertion site that does not require stitches;
• No reported infections, which can sometimes occur after surgery;
• Success rate similar to that of surgery when analyzing post-procedure pain relief, sperm quality, and pregnancy rates;
• Patient remains conscious during procedure.

Dr. Richard Baum, Chief of the Division of Angiography and Interventional Radiology at Brigham and Women’s Hospital and leader of the Vascular and Vein Care Centers, believes the shorter recovery associated with embolization is a particularly important factor for men who are considering their treatment options. “Even though the procedure has been available for the past two decades, recent advances have made the procedure even safer and less invasive,” says Dr. Baum. “This is important, as varicocele patients are typically very active and want to return to work and physical activity as quickly as possible.”

• Surgery

Open surgery continues to be a common treatment for varicocele, but typically is only recommended if the results of embolization are not satisfactory. Varicocele surgery is usually performed by a urologist as an outpatient procedure.

Surgical patients leave the hospital the same day or stay overnight. This is followed by a two- to three-week recovery period.

For more information about testicular varicocele treatment or how to schedule an appointment with an interventional radiologist, please call 617-732-6248 or 866-345-XRAY, or visit the Brigham and Women’s Hospital Angiography and Interventional Radiology website.