Varicocele is a bunch of enlarged veins in a man’s scrotum that feels like a “bag of worms” on touch. A varicocele is a relatively common condition in young men. One out of 10 men suffers from varicocele and occurs mostly on left side with only 1% being right-sided. Varicocele may be asymptomatic or may cause pain, swelling or sometimes infertility. It is the most common identified correctable cause of male infertility.

Why does a varicocele occur? Normally, testes get fresh oxygen rich blood via an artery and the used blood flows out via a network of small veins, which is carried back to the heart. This flow is one-way and reverse flow is prevented by a series of valves in the veins. In some individuals, however, these valves do not work well and the blood flows in reverse direction. This increases pressure in these small veins around the testes, which become enlarged and form a varicocele.

What are the symptoms? Commonly a varicocele is silent and does not cause symptoms. However, some varicoceles cause a dull or aching pain, especially when the person is standing for a long time. In some individuals, a varicocele may cause infertility. As many as 40% of men with decreased fertility have a varicocele. A common explanation is that the varicocele increases the temperature in testes and adversely affects the sperm count and quality. In some men, varicocele can cause shrinking (atrophy) of the testicles and low testosterone levels.

How is varicocele diagnosed? It is best to catch a varicocele before it causes major problems, such as infertility. Self-exam of the scrotum is an easy way to diagnose a varicocele. A varicocele can feel like a “bag of worms”, and is usually found on the left side. USG Doppler confirms the diagnosis and also tells us the severity and stage of the varicocele.

What is the treatment? For men who are having mild or occasional symptoms, the following steps may be enough to control the discomfort: Wearing a jockstrap (tight underwear) Avoiding heavy weight lifting If these measures do not help, the varicocele can be treated with embolization or surgery. The goal of the treatment is to stop reverse blood flow through these enlarged veins. Studies have shown that embolization and surgery are equally effective.

How does Embolization work? Embolisation is a treatment where abnormal blood vessels are sealed through angiography by placement of coils or glue. This procedure is done without any surgery, cuts and stitches. It relieves pain and swelling and may improve sperm quality for infertile couples. A small catheter (thin plastic tube) is inserted into a vein in the arm. X-ray is done to confirm the catheter position. Then, tiny coils made of platinum, or glue is injected in the vein. They block the reverse flow in the varicocele. Blood can still exit the testicle through other normal veins It is done as a day care procedure under local anaesthesia. The patients can be discharged after few hours of observation. This method is least invasive, very safe and has high success rates.

What is the success rate? There is a 90% success rate with embolization. Its safety and effectiveness has been shown in very large studies. Are there any complications associated with varicocele embolization? The complications are rare, which may include coil migration.

What is the cost of varicocele embolization? The cost of varicocele embolization is comparable to the cost of surgery. We will provide you an approximate estimate of the cost during your consultation before the treatment.

What is Varicocele Surgery? Several surgical approaches can be used to close off the faulty veins to correct the varicocele. These include open surgery, microsurgery and laparoscopic surgery. There are some important differences to note with each procedure. Open surgery – a surgeon makes an incision in the groin, finds the faulty veins, and ties them off so blood can’t flow through them. With this approach, there is a higher rate of the varicocele recurring. Microsurgery–performed using a microscope. The surgeon can more easily identify the exact veins. While the procedure is more complex, it has less complications and a lower recurrence rate than the open surgical approach. Laparoscopic – the surgery is performed through small incisions and uses specific surgical instruments to see inside the body and make the repairs. The laparoscopic approach requires patients to undergo general anaesthesia.

Are there any complications of surgery? Varicocele surgery presents relatively few risks, which might include: Accumulation of fluid around the testicles (hydrocele) Shrinking of the testicle on the side of the surgery due to inadvertent damage to artery. This is reported in less than 01 percent of patients Failure to relieve pain

What is best for me? You should discuss your treatment options with your doctor. Some questions to ask include: What are the risks and benefits of Surgery and Embolisation? Is varicocele embolization an option for me? How many days do I need to miss the work or office?