
Varicocele
Urology
Varicocele is an abnormal enlargement and twisting of the veins within the scrotum, similar to varicose veins in the legs. It most commonly affects the left testicle but can also occur on the right or both sides. Varicocele is a common cause of male infertility as it can negatively impact sperm quality and testicular function.
Symptoms
The symptoms of varicocele vary; some men may experience no discomfort, while others may have noticeable signs, including:
- Swelling or a feeling of heaviness in the scrotum, worsening after prolonged standing or physical activity
- Palpable enlarged veins in the scrotum, resembling a "bag of worms"
- Dull pain or discomfort in the testicle, especially after exercise or standing for long periods
- Decreased sperm quality, potentially leading to infertility
- Testicular shrinkage (atrophy), where the affected testicle becomes smaller than the other

Causes and Risk Factors
Possible Causes
Venous valve dysfunction |
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Increased pressure in the left renal vein |
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Nutcracker Syndrome |
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Risk Factors
- Most common in adolescents and young men (ages 15-25)
- Prolonged standing or heavy physical activity
- Genetic predisposition
- Abnormal vein structure in the testicular area
Diagnosis
- Valsalva Maneuver: The doctor asks the patient to hold their breath and strain to detect the enlarged veins while standing.
- Scrotal Doppler Ultrasound: The most common and accurate diagnostic tool used to measure vein enlargement and abnormal blood flow.
- Semen Analysis: If infertility is a concern, a sperm test can evaluate sperm count, motility, and morphology.
- Advanced Imaging (CT Scan or Venography): It is used when an underlying condition, such as a kidney tumor, is suspected.
Treatments
Conservative Treatment |
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Surgical Treatment | When varicocele causes significant discomfort or affects fertility, doctors may recommend surgical treatment. Microsurgical Subinguinal Varicocelectomy
Laparoscopic Varicocelectomy
Percutaneous Embolization
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Microsurgical Subinguinal Varicocelectomy
Microsurgical sub-inguinal varicocelectomy is a minimally invasive procedure designed to treat varicocele. This surgery utilizes microsurgical techniques and a high-powered microscope, allowing surgeons to precisely identify and ligate abnormal veins while preserving essential structures such as the testicular artery and lymphatic vessels.
Surgical Steps
- Anesthesia & Preparation: The patient typically undergoes general anesthesia. A urinary catheter may be placed before the procedure to assist with urination.
- Incision Placement: A small incision (about 3 cm) is made below the inguinal area (subinguinal approach).
- Microscope Assistance: Using a high-powered microscope (10-12x magnification), the surgeon can visualize swollen veins, delicate testicular arteries (approximately 1 mm in diameter), and lymphatic vessels.
- Vein Ligation: Abnormal veins are carefully ligated while preserving the testicular artery to maintain proper blood supply and prevent testicular atrophy.
- Wound Closure: The incision is closed with sutures or staples and covered with a sterile dressing.
Advantages of the Surgery
- Low Recurrence Rate
Medical studies indicate that microsurgical varicocelectomy has the lowest recurrence rate, ranging from 0.8% to 4%.
- Fewer Complications
Microsurgical precision helps protect the testicular artery and lymphatic vessels, reducing the risks of testicular atrophy and scrotal hydrocele.
- Minimally Invasive & Faster Recovery
Smaller incisions lead to less postoperative pain, and most patients can be discharged the next day and resume normal activities quickly.
Indications for Surgery
- Male Infertility
Varicocele is strongly linked to male infertility, and surgery can improve sperm quality and increase the chances of conception.
- Testicular Pain or Discomfort
For patients experiencing scrotal or testicular discomfort due to varicocele, surgery provides effective symptom relief.
- Testicular Atrophy
If testicular shrinkage is detected in adolescents, surgery can help prevent further atrophy and support normal testicular development.
Postoperative Care
- Activity Restrictions
Avoid strenuous exercise or heavy lifting for one-month post-surgery.
- Wound Care
Keep the incision clean and dry, follow medical instructions for proper wound care, and attend scheduled follow-up appointments.
Related Doctors
Related Services
Benign Prostatic Hyperplasia (BPH)
Cancer
Infertility
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