Varicocele

What are varicoceles?

Varicoceles are dilated veins of the testicles.  In fact, they are varicose veins.  It is the most common cause of male infertility with 40% of sub-fertile males having this condition.  Varicocele is even more common in men who have previously fathered children and are now unable to do so.

How are varicoceles diagnosed?

They are diagnosed by physical examinations and by ultrasounds.

How do varicoceles affect fertility?
Varicoceles may cause progressive injury to the production and the maturation process of sperm with worsening sperm count over time.  The majorities are on the left and some are on both sides.

The mechanism by which varicocele impairs fertility in a matter of ongoing debate.  The most likely explanation is the abnormal elevation of scrotal temperature.  Normal scrotal temperature is a few degrees lower than the core body temperature as required for normal sperm production and maturation to proceed.

Not all varicoceles are associated with male infertility.  15% of all men have varicoceles and only
a small proportion of these men present to us for infertility evaluation.  The reason(s) behind this inconsistency is not known; it may be due to individual difference in susceptibility, compensation by female fertility or excellent baseline male fertility such that despite varicocele-induced impairment, overall fertility has not been sufficiently reduced.

How do varicoceles affect sperm production?
Varicoceles affect seminal parameters in many ways.  These include reduction in sperm count, motility, morphology, sperm penetration scores and possibly the production of anti-sperm antibodies.  An adequate semen analysis result does not rule out male factor infertility and additional studies may be required.

How are varicoceles treated?

Treatment is surgical in the vast majority of the cases.  All of the surgical procedures are done on an outpatient basis.  Different approaches include an inguinal (or groin) or laparoscopic approach. The inguinal approach may be done with the aid of an operating microscope (microsurgical), which is used to provide our urologist with optical magnification in order to identify all venous tributaries and to preserve the testicular arteries and lymphatic channels.

The procedure is performed on an outpatient basis.  A variety of anesthesia can be used including general, spinal or local anesthesia (lidocaine) with intravenous sedation. The procedure itself takes about 60 to 90 minutes per side.

The postoperative care includes oral pain medications and several doses may be all that is required.  You may then take Tylenol or Motrin on an as-needed basis.

How does the surgery improve fertility rates?
Surgical ligations (tie off) of varicoceles result in 70% of patients having improvement in their semen analysis and 40% of the couples achieving pregnancy.

Can varicoceles reoccur?
Recurrence rates are the lowest in the microscopic approach and are around 1-2%.  Recurrence rates for laparoscopic and radiographic approaches are higher.

What are the complications of surgery?
All types of surgery have the risks of bleeding and infection.  Scrotal swelling (hydrocele) is noted in up to 15% of all patients undergoing non-microsurgical open repair.  Hydrocele is seen rarely with microsurgical repairs.

What is the recovery time?
You should engage in only minimal activity for 24 hours and may be off work for up to 2-3 days.  No heavy lifting for 5-7 days and you may shower immediately and bathe in 7 days. Most men return to work within 2-3 days provided they have mostly desk jobs.