Varicocele Repair


What is varicocele?

Varicocele RepairA varicocele is an anatomic abnormality resulting from dilated veins of the testicle. This can result in decreased sperm concentration, decreased sperm motility, and decreased sperm morphology. Varicocele repairs have been shown to statistically improve sperm parameters, including the critical total motile sperm count and even sperm morphology. If your goal is to get pregnant quickly as possible, then a physical exam is necessary to rule out a varicocele.

Symptoms of varicocele

Individuals with a varicocele may experience discomfort or dull pain in the scrotum or testicle. Varicoceles may result in infertility and testicular atrophy (shrinkage). No symptoms may be present  and patients are asymptomatic.

Evaluation and treatment

Scrotal swelling or testicular enlargement should be evaluated by a urologist as other pathology may be present.

A history and physical examination is performed to evaluate for predisposing conditions.
If a varicocele is suspected but the diagnosis is uncertain, a scrotal ultrasound is usually obtained.
If a varicocele is large, painful, associated with testicular shrinkage, or discovered in a man who is unable to father a child, treatment should be considered.


What causes a varicocele?

There are a series of one-way valves within the veins that take blood away from the testicles. If these one-way valves fail, it can have a domino effect and result in other valves failing. The end result is a dilated vein exiting the testicle, which is called a varicocele.

How can a varicocele worsen sperm parameters?

A varicocele causes "stress" to the testicle. There are many theories for how a varicocele can cause "stress" to the testicle. One common theory is that it increases the temperature of the testicle and also increases the reactive oxidative species. The end result is that the testicles’ function can be impaired: leading to decreased sperm parameters and decreased testosterone levels.

How can a varicocele be ruled out?

A physical exam by an experienced urologist is the most reliable way to rule out a varicocele. Varicoceles that are discovered on a physical exam can be characterized into three categories depending on the severity: grade 1-palpable only with a bearing down maneuver, grade 2-palpable without bearing down, and grade 3-the largest kind of varicocele which can be spotted by just visual inspection.


What is varicocele repair?

A varicocele is a dilation of veins surrounding the testicle. It is quite common affecting 15-20 percent of males. Varicoceles usually occur on the left side and may be bilateral in 30% of patients. Right-sided varicoceles are rare and should be evaluated by a urologist promptly.

How can a varicocele fixed?

The varicocele repair can be performed as an outpatient procedure and most men can return to work within a few days. Different techniques have been used to repair varicoceles. Some methods involve surgery through a groin incision while others use a laparoscopic approach.

With an infertile couple, the goal of a varicocele repair is to improve semen parameters. Research has shown that after a varicocele repair, a couple’s chances of a pregnancy can be increased by more than 3 times and sperm parameters also improve significantly.

The other significant potential benefit of a varicocele repair is that it can help a man with his testosterone level. The testosterone level is important with respect to a man's energy level, sex drive, and erection function.

Treatment for varicoceles consists of ligation/interruption of the enlarged veins as an outpatient surgical procedure. This can be done laparoscopically (laparoscopic varicocelectomy) in certain individuals. Other techniques for vein ligation involve the use of an operating microscope and a tiny incision in the scrotum.