Varicocele

A varicocele is an enlargement of the veins inside the scrotum, similar to varicose veins in the leg. It is found in about 15 in 100 men, nearly always on the left side, and usually appears during puberty.

Most varicoceles cause no trouble and need no treatment. They matter in three situations: when they cause an aching pain, when they are associated with reduced sperm quality in a couple trying to conceive, and when they slow the growth of the testicle in an adolescent. Repair improves semen measurements in many men, although it does not ensure a pregnancy.

Symptome

• Usually no symptoms
• A dull ache or heaviness in the scrotum that worsens with standing or exertion and eases on lying down
• A soft swelling above the testicle, described as feeling like a bag of worms, which shrinks when you lie down
• A left testicle that is smaller than the right
• Difficulty conceiving, with abnormal results on semen analysis

Ursachen und Risikofaktoren

The valves in the testicular vein fail, so that blood flows backwards and pools in the network of veins around the testicle. The left side is affected because the left testicular vein is longer and joins the kidney vein at a right angle, under higher pressure. The pooled blood raises the temperature of the testicle and increases oxidative stress, which can impair sperm production and the quality of sperm DNA, and sometimes lowers testosterone. A varicocele that appears suddenly in an older man, that is on the right side only, or that does not empty on lying down requires imaging of the abdomen, because a mass may be blocking the vein.

Wie es diagnostiziert wird

• Physical examination: Performed standing in a warm room, with and without straining. Varicoceles are graded 1 to 3 by size.
• Scrotal Doppler ultrasound: Confirms enlarged veins with reversed flow and measures the volume of the testicles.
• Semen analysis: Two samples several weeks apart if fertility is the concern.
• Hormone tests: FSH and testosterone in men with abnormal semen or small testicles.
• Abdominal imaging: For a varicocele that is sudden, right-sided or does not collapse.

Behandlungsmöglichkeiten

• Observation: For men without symptoms, with normal semen or no wish for children. Adolescents have a yearly check of testicular size.
• Supportive measures for pain: Snug underwear, anti-inflammatory painkillers and avoiding prolonged standing.
• Microsurgical subinguinal varicocelectomy: Performed through a 2 to 3 cm incision in the groin under an operating microscope. The veins are tied while the artery and the lymphatic vessels are spared. It has the lowest rates of recurrence and hydrocele, and is done as a day case.
• Laparoscopic varicocelectomy: An alternative, sometimes chosen for varicoceles on both sides.
• Percutaneous embolisation: A radiologist blocks the vein with coils or a sclerosant through a vein in the groin or neck under local anaesthetic. Recovery is quick and the recurrence rate is somewhat higher.
• Assisted reproduction: IVF or ICSI when semen quality remains poor or female factors predominate. Repair of the varicocele beforehand may improve the results in selected couples.

Wenn es dringend ist

Sudden severe pain in a testicle, especially with nausea or with the testicle lying high in the scrotum, may be torsion and needs an emergency department within hours. A hard lump within the testicle itself should be examined promptly. A varicocele by itself is never an emergency.

Reisen nach Türkiye zur Behandlung

Microsurgical repair is a short, planned day-case operation that fits a stay of 4 to 6 days and is often combined with a fertility assessment of both partners. Be realistic about timing. Sperm take about 3 months to form, so semen is rechecked at 3 and 6 months, and the benefit for natural conception appears over 6 to 12 months. If the female partner is over 35 or has reduced ovarian reserve, discuss whether waiting is sensible or whether IVF should go ahead in parallel.

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