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FROM UVA RADIOLOGY & MEDICAL IMAGING

Condition: Varicocele

men's health varicocele header

Many people have heard of varicose veins in the legs, but did you know that a similar vein condition can occur in the scrotum? When this occurs, the vein is called a varicocele. Varicoceles are enlarged, failing veins in the scrotum that can cause daily discomfort, including aching and swelling in the testicles.

Article Reviewed by Auh Whan Park, MD


Varicocele: What is it?

The spermatic cord is a bundle of veins, nerves, and blood vessels that connect the testicles inside the scrotum to the abdomen. Healthy veins in the spermatic cord have valves inside them that circulate blood from the testicles to the scrotum and back to the heart.

In a varicocele, the valves in the vein fail to effectively move blood back to the heart, causing blood to pool in the vein. This results in an enlarged or swollen testicular vein called a varicocele.

Like varicose veins, the exact cause of varicoceles is unknown. Although there are no established risk factors for varicoceles, about 15% of adult males and 20% of adolescent males have varicoceles.

Symptoms:

Varicoceles do not always present noticeable symptoms. However, if you have varicoceles you may notice:

  1. An achy or heavy feeling the scrotum, especially when standing for long periods of time
  2. Visibly enlarged or gnarled looking veins (some men report these look like a bag of worms)
  3. Swelling in the testicles
  4. Tenderness to the touch

A varicocele is rarely a serious health issue. However, if the varicocele is severe it can raise the temperature around the testicle, lowering sperm production or decreasing the quality of sperm. It can also cause testicular atrophy–shrinkage of the testicle– which can compromise sperm production as well. Because varicoceles can affect the quality of sperm, men with varicoceles and fertility issues should talk to their doctor about the best way to deal with this condition.

Diagnosis:

Varicoceles are usually diagnosed through a physical exam where your physician examines you while standing. Your doctor is able to determine whether you have varicocele from the appearance of your scrotum veins, but may also feel for tenderness. Your physician may also order a scrotal ultrasound to get a detailed picture of your veins and screen for other potential causes of the varicocele.

Treatment:

As mentioned above, varicoceles are rarely a serious medical issue. For mild cases of varicoceles, doctors will often recommend wearing tight underwear or a jock strap to provide support and lesson painful symptoms. For more severe cases, your doctor may consider other treatment options like the following:

1. Open surgery

The surgeon makes a one inch incision below the groin and uses a magnifying glass or operating microscope to see inside the vein. The vein is then clamped or tied off to prevent blood flow to the dysfunctional vein and redirect blood to healthy veins. This is the most invasive of the treatments with recovery time usually lasts 7 to 10 days.

2. Laparoscopic Surgery

The surgeon makes a very small cut in the abdomen. Then they insert a scope with a tiny camera into the incision to see inside the body. Once the swollen veins are identified, the surgeon will seal them off with tiny clips or heat.

3. Varicocele Embolization

The least invasive procedure option. Varicocele Embolization is performed by interventional radiologists to treat the malfunctioning vein. Using fluoroscopy, an imaging machine that provides continuous x-ray images, the interventional radiologist inserts a small catheter through a very small incision into the the femoral artery, jugular vein, or arm vein. The catheter is then guided into to the affected testicular vein. The interventional radiologist then either places a small coil into the vein to block blood flow or injects a medicine which causes the vein to close up. Once blood is rerouted to nearby healthy veins, blood flows more efficiently through the scrotum and back to the heart. Over a few weeks, the treated vein disappears and is reabsorbed by the body.

A graphic showing the 3 main advantages of varicocele embolization

Varicocele Embolization has some advantages over surgical treatments. For instance, this procedure uses local anesthetics combined with IV sedatives rather than general sedation. It is also a much less invasive procedure since it only involves making a slight incision in the skin. Because of the way the procedure is performed, recovery time is much shorter as well and most patients are able to resume normal activities within 24 hours.

UVA Interventional Radiology’s team of skilled providers are able to screen for varicocele and provide minimally invasive treatment like varicocele embolization. If you notice these symptoms, including the appearance of large veins in your scrotum, contact Dr. Auh Whan Park to schedule a consultation or call +1 (434) 924-9401.

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