Varicocele Diagnosis and Treatment: What You Need to Know

Doctor and patient discussing diagnosis of varicocele

What do you do with a bag of worms?

If you’ve been following my recent blogs or reading the varicocele pages on my website, you probably know that varicoceles are enlarged veins next to your testicles. They usually feel like a bag of worms, they’re fairly common, and they can be uncomfortable. They can also heat up your testicles, which can reduce your fertility and your testosterone levels.

How are varicoceles diagnosed?

If you think you might have a varicocele, you should see a urologist to confirm it. During the visit, the urologist will check your scrotum. You may be asked to hold your breath and bear down, which can cause the varicocele to stand out more. If this isn’t enough to be sure, you might undergo an ultrasound procedure to help your urologist see inside your scrotum.

Should I get treated for varicoceles?

If have a varicocele and you’re in pain or you’re having trouble fathering a child, you may want to consider treatment. If these aren’t issues but you’re still concerned, talk it over with your urologist.

Varicocele treatment generally accomplishes four things:

  • It seals off any malfunctioning veins
  • It relieves discomfort
  • It returns the blood flow to normal
  • It improves your fertility

How are varicoceles treated?

There are three main ways to treat varicoceles. Here’s a description of each:

Open surgery

With this type of surgery, the doctor makes a one-inch cut in your lower abdomen and then uses a magnifying glass or a microscope to help see the veins that need attention. You might get local anesthesia to numb the area or you might get general anesthesia, which makes you sleep through the procedure. You can probably go back to work in two to three days after surgery. But you’ll need to take it easy and avoid exercise and sex for about two weeks.

Laparoscopic surgery

With laparoscopic surgery, the doctor makes a much smaller cut and uses it to insert tubes that hold surgical tools and a tiny camera. This procedure is usually done with general anesthesia. Recovery is the same as for open surgery.

Varicocele embolization

With this less-common procedure, a doctor called a radiologist cuts into a vein — usually in your groin — to insert a tube called a catheter. Using X-rays, the radiologist guides the catheter to the varicocele and then inserts a balloon or coil into the varicocele. This blocks the blood flow to the varicocele and shrinks it. This procedure is also done with general anesthesia. Recovery after an embolization is a little quicker: You’ll still need to take a day or two off from work, but you can usually start exerting yourself a week to 10 days after the surgery. Your varicocele may be more likely to come back after this treatment.

While all types of surgery have potential risks and complications, these three approaches are all relatively low-risk. Also, in some cases, the varicocele doesn’t go away or it may come back. If this happens, you may want to go for surgery again.

If you had the procedure to help with your fertility, you should schedule a fertility evaluation for three to four months after your surgery. That’s how long it takes for new sperm to grow.

If you’re trying figure out which approach would be best for you, talk to your urologist. The best choice will depend on what you’re trying to accomplish, as well as your specific condition, needs and concerns.

To find out more about varicoceles or come in for an examination, contact Dr. Harry Fisch in New York for a consultation.

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