Treatment and Prevention of Varicocele

Varicoceles can be corrected surgically or managed conservatively using non-surgical methods.

Surgical Treatment

Surgical treatment

Surgical treatment

Surgical repair of a varicocele is the most effective and, in the long-run, the most cost-effective treatment of a varicocele. Varicocele repair has been shown to improve the patient’s semen analyses and therefor improve fertility.  Pain and discomfort is also dramatically improved and further damage to the testes is stopped. All surgical methods involve ligation of affected veins to prevent abnormal blood flow. A varicocele can reappear after surgery but the recurrence rate is low, usually less than 10%.

 

Surgical repair is recommended for men with the following symptoms or signs:

  • Severe Pain or discomfort
  • A varicocele should be corrected surgically if the patient has significant testicular discomfort or if the pain

  • Testicular atrophy
  • It should also be the method of choice if atrophy of the testes has already taken place. (i.e. the volume and length of the testes is below a certain threshold.)   Surgery is especially advised if the discrepancy between the testicles is more than 10%.  This may not be reversible so it is better if surgery is done earlier.

  • Infertility
  • Surgery is performed if the patient is reporting infertility and also to prevent further damage to the testes.

  • Grade 2 or 3 Varicoceles
  • Adult men who have a moderate or large varicocele and an abnormal semen count but are not attempting to conceive should also consider surgical repair.

  • Bilateral varicoceles
  • If varicoceles are present in both testes, surgical treatment is usually recommended.

  • Varicocelectomy – via open incision
  • A varicocelectomy is the name of the surgical procedure used for the correction of a varicocele and is often done on an outpatient basis. Surgeons use various different techniques and approaches to perform this procedure. They can either reach the varicocele from an incision just above or below the scrotum

    The patient is usually sedated but not intubated which is considered the safest option for the patient. General anesthesia is not usually necessary but every case is individualized so the urologist and anesthesiologist will decide on the best treatment for every individual patient.

    A local anesthetic is injected into the site (usually in the inguinal area, about 1,5cm to the left of the base of the penis) before the incision is made. The incision is made when the area is numb. The surgeon then locates the spermatic bundle and lifts it out of the patient’s body with clamps. The affected veins are carefully identified and surgically severed. The surgeon takes care not to harm any of the other vessels in the cord. The cord is then placed back in position and the area is closed layer by layer. Pubic hair should cover the area of the scar once the wound has healed. The patient feels nothing during the procedure and recovery time is usually quick. Because this is an outpatient procedure, the patient can usually go home on the same day that the procedure took place.

  • Varicocelectomy – via laparoscopy
  • With a laparscopic approach, the surgeon makes 3 tiny incisions in the patient’s abdomen and passes small, surgical instruments through the incisions to see and to repair the varicocele. The laparoscopic procedure offers the same success rate as the open repair. Whether the surgery will be done laparoscopically or not will be decided by the urologist after evaluation of the patient. Availability of equipment as well as every surgeon’s skills and preferences also play a role.

  • Varicocele embolization
  • Embolization of affected veins is an alternative to a varicocelectomy. It is a newer type of treatment and a varicocelectomy is till the surgery of choice. It involves a small wire being passed through a peripheral vein and, with the use of a catheter; the surgeon obstructs the vein in the abdomen which is transmitting increased pressure to the testicle. Because this is minimally invasive, recovery time is quicker than with a varicocelectomy but varicocele embolization is still somewhat controversial.

Normal activity may be resumed 2 days after surgical repair of a varicocele.  Exersise should only be resumed 2-4 weeks post-surgery.

Semen samples for analyses are typically obtained three to four months after the correction procedure was done and then repeated again after 6 months. Improvement in sperm count is often noted within six months after surgery, but may not be observed until one year after the procedure.

 

Non-surgical Management of varicoceles

There is no effective medical treatment of varicoceles.  Medical Management is focused on symptomatic relief of discomfort and pain.

Symptomatic Relief of a Varicocele:

  • Non-steroidal anti-inflammatories
  • Taking non-steroidal anti-inflammatories can help to symptomatically relieve pain. This is just treating the symptoms and not a specific treatment.  If the pain continues, surgical repair of the varicocele should be strongly considered.  Pain pills can be used while the patient awaits the date for his surgery.  It is important for the patient to tell the doctor about pain pills because many non-steroidal anti-inflammatories, like Aspirin, decrease the blood’s clotting ability and can lead to excessive bleeding during surgery.

  • Supportive Underwear
  • Some doctors recommend supportive underwear which can help to relieve some pain as it assists with blood flow.  It is important to remember that underwear should be supportive and not restrictive

  • Lying down
  • Lying down should relieve some of the pain caused by a varicocele, although only slightly and temporarily.  If the pain is really severe surgery is highly recommended.

 

Preventative Measures:

  • Avoiding hot temperatures
  • Hot temperatures will cause further dilatation of the veins and therefor will worsen the symptoms of a varicocele. So avoiding hot weather and hot baths can help to relieve symptoms and possibly prevent further pain.

  • Healthy lifestyle
  • General methods to improve fertility would include healthy lifestyle and healthy eating. A varicocelectomy or embolization may be necessary if there is already decreased sperm count and atrophy of the testicle.

  • Avoid heavy lifting
  • Any activity which increases intra-abdominal pressure like body-building or lifting heavy objects can worsen a varicocele because of the increased pressure. If the patient has no pain, body-building is not contra-indicated.

Failure to treat a varicocele may result in a decline in semen quality and sperm count. This may lead to infertility. A varicocele also causes the testicle to atrophy and may, over time, lead to permanent, irreversible testicular injury.  Without surgery, pain and discomfort experienced with a varicocele might be permanent.

Besides for possible infertility, pain and discomfort, a varicocele is not life threatening.  All scrotal masses should be investigated by a medical professional to exclude a dangerous cause or a condition needing immediate treatment.