Treatment for Varicocele
If the patient with varicocele is asymptomatic and infertility is not an issue, no treatment is warranted. If the discomfort is mild, the condition usually can be managed by wearing an athletic supporter or snug-fitting underwear during strenuous activity or exercise.
Surgery to Treat Varicocele
If the varicocele causes pain or atrophy (rare) or if the condition is causing infertility (most common), surgery may be recommended. Most varicoceles can be corrected through a surgical procedure called varicocelectomy (i.e., surgically "tying off" the affected spermatic veins). The following methods are used.
Surgical ligation usually requires general or reginal anesthesia. In this procedure, a 2- to 3-inch incision is made in the groin or lower abdomen, the affected veins are located visually, and the surgeon cuts the veins and ties them off above the varicocele to reroute the blood through unaffected veins. Surgery can be performed on an in- or outpatient basis. The patient typically can resume light activity within a week and strenuous activity in about 6 weeks.
Embolization is a nonsurgical procedure that takes about an hour and a half. A small tube (catheter) is inserted into a small incision in the groin to block the flow of blood to the varicocele. Venography is used to highlight the varicocele on x-ray and to visually guide the catheter. The catheter is then used to push tiny coils into place to block the blood flow to the dilated vein. This eases the pressure, reduces enlargement, and restores normal circulation. Light sedation, sometimes called "twilight anesthesia," is used during the procedure; the patient does not lose consciousness. Stitches are not needed. Normal activity is usually resumed within 2 days.
Laparoscopy is a technique in which the surgeon inserts a tiny camera attached to a long tube into the abdominal cavity through a small incision. Using the camera to locate the varicocele, the surgeon then inserts other instruments through the same incision to isolate and tie off the dilated veins. This technique requires a smaller incision than surgical ligation and is sometimes regarded as less invasive. The laparoscope, however, can sometimes damage abdominal organs, which is not a risk factor in open surgery. The procedure takes about 2 hours and recovery about 2 days.
Between 5% and 20% of patients experience a recurrence. In such cases, the procedure usually is repeated. Another 2% to 5% develop a condition called hydrocele, a fluid-filled cyst that forms around the testicle. Minor surgery is used to correct this problem.
About 50% of men who undergo varicocelectomy to correct infertility father children within the first year. It takes about 90 days for a sufficient quantity of new sperm to be produced to permit fertilization. Semen analysis usually is done at 3- and 6-month intervals after the operation. (see Male Infertility).