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Varicocele (enlargement of the veins of the spermatic cord)

A varicocoele is the enlargement of the network of veins that drain the testicle in males.

What is going on in the body?
Blood flows from the scrotum and testicles through a complex of veins rather than a single vessel. These veins are prone to becoming enlarged or dilated. This frequently happens when the valves in the veins that keep the blood flowing in the direction of the heart become weakened. A varicocoele is more common on the left because of the specific pattern of blood flow on that side. Varicocoeles are linked to infertility in males 20 to 40% of the time. This is because the increased blood flow through the enlarged veins raises the temperature of the testicles and affects the development of sperm.

What are the signs and symptoms of the condition?
Most varicocoeles do not have symptoms. They are found by accident during a routine examination or an infertility evaluation. Very large varicocoeles may produce a heavy or dragging feeling in the testicles. They rarely are painful.

What are the causes and risks of the condition?
Approximately 15% of adult men have a small to moderate size left varicocoele. Right-sided varicocoeles are uncommon. Typically, the presence of a varicocoele does not signal any type of serious disease. However, a large varicocoele on the right side that appears suddenly may indicate a mass such as an enlarged lymph node or testicular cancer.

What can be done to prevent the condition?
There is no known way to prevent developing a varicocoele. Routine testicular self examination may alert the man to any new masses, which should be evaluated by the doctor.

How is the condition diagnosed?
A varicocoele is usually diagnosed with a physical examination. It appears as a full but soft mass above the testicle. The mass disappears completely when the man is lying down. The varicocoele's appearance has been described as a "bag of worms." Ultrasound is sometimes used to confirm the diagnosis. This is more common during an evaluation for male infertility.

What are the long-term effects of the condition?
Varicocoeles can be linked to male infertility. If abnormalities show up in a semen analysis, removing the varicocoele may improve sperm quality.

What are the risks to others?
There are no risks to others, as a varicocoele is not contagious.

What are the treatments for the condition?
A varicocoele is usually managed conservatively. A scrotal support may be worn to relieve the heavy sensation in the scrotum. However, if the pain continues or if infertility results from a back-up of blood in the veins, surgery may be needed.

Removal of the varicocoele is called varicocoelectomy. This operation can be accomplished with a variety of incisions. The most common is a small cut in the groin or just below it. Several of the veins draining the contents of the scrotum can be tied off through this opening. An alternative procedure is to make a small incision higher up in the flank. Also, the enlarged veins can be blocked with material injected into them through a catheter, or narrow tube.

What are the side effects of the treatments?
Side effects may include bleeding, infection or the accumulation of fluid along the spermatic cord, known as a hydrocoele.

What happens after treatment for the condition?
The man will feel some discomfort and a sense of congestion in the testicle for a few weeks following the procedure.

How is the condition monitored?
If the varicocoele makes the scrotum feel uncomfortably full, or impairs fertility, the male should follow up with a doctor. Any new or worsening symptoms should be reported to the doctor.

Author: Stuart Wolf, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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