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There are several treatment options for varicocele, depending on symptoms and seriousness of the condition. If the varicocele is not causing any symptoms of pain and infertility is not an issue, no treatment is warranted.
Our centre practises the transinguinal approach where a small incision is made over the groin. Complications are uncommon and include wound infection (5%), bleeding leading to hematoma (5%), testicular artery injury (1%) and hydrocele formation (1-5%).
We have arrangements with an interventional radiologist to perform embolization of varicocele.
Our centre prefers to reserve the embolization option for cases of varicocele recurrence after a surgical ligation. A varicocele is a scrotal abnormality defined by elongated, dilated and tortuous veins that drain the testicle (Figure 1). Several theories have been proposed to explain their occurrence, including poorly functioning valves and increased resistance to blood flow where the varicocele veins drain, creating a “dam-like” effect and increasing venous pressure. To learn more about varicoceles and treatment options, including surgery, please select one of the following topics.
A grade III varicocele seen as bulges under the skin above the patient’s left testicle.The “gold standard” way to diagnose varicoceles is by physical examination. Varicoceles have been arbitrarily divided into 3 grades based upon physical examination findings (Table 1). The diagnosis of varicocele can also be made with venography, ultrasound, thermography, scintigraphy and CAT scan or magnetic resonance imaging. An adolescent with a large varicocele and evidence of a smaller testis on the side of the varicocele.
The goal of varicocele treatment is to stop the backward flow of blood from the body to the scrotum, and therefore to “cool off” the testicles. In cases of mild discomfort, the condition usually can be managed by wearing an athletic supporter or snug-fitting underwear during strenuous activity or exercise. The distended varicocele veins are identified with the aid of an operative microscope and surgically ligated and divided. Dr Ho is a well-trained laparoscopic urology surgery who has extensive experience with laparoscopic varicocelectomy.



By using coils or balloons, blood flow to the varicosed veins is blocked and is re-directed to other healthy pathways. Pain from the surgical wound is minimal and can usually be controlled with tablet painkillers. Varicoceles are common, observed in 15% of the general male population, and are presumably an evolutionary consequence of men’s upright posture. They do not cause cancer and are not life threatening, but are simply an anatomic consequence of being human. Varicocele (V) is the blue set of veins that drain blood from the testis to the body.Most varicoceles are asymptomatic. Turek’s practice who are evaluated for infertility will have a varicocele, a much higher rate than that found in the general population (15%). With a patient in a standing position, palpation of the scrotum by a well-trained physician can reveal a varicocele.
Subclinical varicoceles are lesions not detected by routine examination, but are suggested by radiologic or other imaging methods. Venography is considered to be the best diagnostic test, but it is invasive, involving catheterization of large leg veins to access this system. To achieve this, veins leading from the testis to the body are tied off or interrupted as completely as possible.
The use of an operative microscope, which offers upto 6 X magnification, is necessary to identify clearly the dilated veins and avoiding injury to artery and lymphatics. Over the last 50 years, this had led to the intensive study of the relationship between varicoceles and male infertility.
Conveniently, venography can be combined with embolization using balloons or coils to treat varicoceles at the same time. A single vein is left open (vasal vein) that is not subject to the same issues as the varicose veins and allows the blood to leave the testicle after surgery.
This pain is generally mild to moderate, occurs with long periods of sitting, standing or activity and is relieved by lying down. The mechanism by which a varicocele on one side can affect the fertility of both testicles is not clearly understood.
Doppler ultrasound is less invasive than, and correlates well with, venography and relies on the detection of venous flow within the varicocele.


Although it can be uncomfortable before bedtime (after a long day of activity), it generally does not occur upon awakening after a night’s rest. What is true is that the temperature of the scrotum is normally several degrees cooler than body temperature, which is important for normal sperm production and testis function. Grades I-III are considered “clinical” varicoceles, as they are found on physical examination alone. Surgical or incisional methods are performed in the upper scrotum (subinguinal), groin area (inguinal) or lower abdomen (retroperitoneal). Turek prefers to have patients do if there is a question about whether or not a patient has varicoceles. The procedure can also be performed with “telescope” surgery (laparoscopy) and also by an interventional radiologist through a procedure called venography and embolization (Table 2). It is not associated with urination issues or erectile dysfunction; however, it is associated with male infertility. The dilated veins in a varicocele may decrease the effectiveness of this natural cooling mechanism and “overheat” the testis and reduce its ability to function. Thermography, scintography and MRI or CAT scans are of limited clinical use for varicocele mostly because of increased cost, and lack of controlled studies surrounding their use.
Exactly how heat affects sperm production is currently the subject of much male fertility research. However, a leading theory suggests that increased oxidative stress reduces the fertility of varicocele patients. In addition, there is recent data that shows that sperm DNA fragmentation rates, a measure of sperm quality, can be elevated in men with varicoceles and that varicocele repair can significantly lower these rates. In any case, the semen analysis in varicocele patients can show impaired sperm numbers, movement or both.



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