Varicocele is an enlargement of veins in the scrotum, which is the bag of skin that holds the testicles. This condition is similar to varicose veins that usually occur in the legs, ankles, and feet.

In general, varicocele is not harmful, and if it is not bothersome to the individual, it may not need to be treated. However, varicocele can cause fertility problems in some people by contributing to low sperm production and low sperm quality.

Additionally, it is possible that varicocele can be associated with persistent discomfort or pain despite the use of nonsurgical treatment options such as taking over-the-counter pain medications or wearing tighter-fitting underwear. When an individual is having fertility issues or ongoing testicular pain related to varicocele, they may choose to treat varicocele through surgery to restore their fertility and/or increase their comfort.

Treating varicocele with surgery typically involves tying off the problematic vein so that the blood can flow through normal, healthy veins instead. There are a couple of different ways to do this. A surgeon can stop the blood flow through the varicocele by stitching or clipping the affected veins shut. The two main types of surgeries are as follows:

1. Microscopic varicocelectomy: For this procedure, the surgeon makes a small cut near the groin and uses a special microscope to see and block the small, affected veins. It usually takes about 2 to 3 hours.
2. Laparoscopic varicocelectomy: This surgery involves a tiny camera and surgical tools attached to tubes that are inserted into the body through small cuts in the lower abdomen. Then, the surgeon uses these tools to tie off the problematic veins. Since there are fewer veins to block in this area of the body, this method is faster, taking about 30 to 40 minutes.

In most cases, these surgeries require the patient to be asleep during the procedure. As an outpatient procedure, the individual can usually go home on the same day.

After the surgery, the doctor may prescribe the patient a pain medication to take for a limited amount of time. Then, over-the-counter medications may be recommended for managing any remaining discomfort, but the pain from surgery is generally very mild.

The surgeon or primary care doctor can offer guidance on when the patient may be able to go back to work and resume activities such as exercise and sex.

Embolization is an alternative to surgery for treating varicocele. For this procedure, a medical professional with experience in imaging (a radiologist) will insert a tiny tube into the body, usually in the groin area, and use imaging on a monitor to navigate to the correct site. Then, they will release coils or a solution into the body that will cause scarring and create a small dam in the blood vessel to redirect blood away from the testicular veins.

References:

• Cleveland Clinic. (2023, March 30). https://my.clevelandclinic.org/health/diseases/15239-varicocele
  
  
• Mayo Clinic. (2022, March 3). https://www.mayoclinic.org/diseases-conditions/varicocele/diagnosis-treatment/drc-20378772
  
  
• UCLA Health. (2023). Varicocele: Symptoms, Treatment, Diagnosis. https://www.uclahealth.org/medical-services/urology/varicocle-symptoms-treatment-diagnosis