Varicocele is a vascular disease that arises as a result of the enlargement of the veins in the testicles and the disruption of blood flow in these veins. It is most commonly seen in the left testicle and is one of the most common, and at the same time treatable, causes of male infertility.
What is varicocele?
With the enlargement of the veins around the testicle (the pampiniform plexus), the backflow of blood is disrupted. This leads to an increase in testicular temperature and, over time, a negative effect on sperm production.
Symptoms
Varicocele often progresses silently, but in advanced cases the following findings may be seen:
- Dull pain or a feeling of discomfort in the testicle
- A feeling of heaviness that increases with standing
- Prominence of the veins in the testicle (a “bag of worms” appearance)
- A decline in sperm quality
- Shrinkage in testicular volume in advanced cases
Why is it important?
The most critical effect of varicocele is that it disrupts sperm production by increasing testicular temperature. Over time, this can cause changes that lead to infertility, such as:
- A decrease in sperm count
- A decline in motility
- Structural deterioration
Diagnosis
- Physical examination (particularly evaluation while standing)
- Scrotal Doppler ultrasonography
- Sperm analysis (spermiogram) when necessary
Treatment options
The treatment decision is made according to the patient’s clinical condition:
- Follow-up (in mild and asymptomatic cases)
- Microsurgical varicocelectomy (the most successful and up to date method)
- Laparoscopic / endovascular interventions (in selected cases)
Microsurgical methods are the treatment approach with the lowest recurrence and highest success rate today.
Frequently Asked Questions
Does varicocele go away on its own?
No. It is generally a progressive disease and does not resolve on its own.
Does every varicocele require surgery?
No. If sperm values are normal and there are no complaints, it can be monitored. However, if there is infertility, surgery is recommended.
Does sperm improve after surgery?
In most patients, a significant improvement in sperm parameters can be seen.
Does varicocele cause pain?
Yes, it can cause dull pain that increases especially with prolonged standing.
Clinical Summary
Varicocele is one of the most important yet treatable causes of male infertility. Early diagnosis and an appropriate surgical approach are of critical importance for the improvement of sperm quality and the increase in the chance of fertility.
