What is Varicocele? Diagnosis and Treatment – Dr. A. Kadir Tepeler, MD

What is Varicocele?

Varicocele is a condition caused by abnormal enlargement of the veins (veins) that remove the dirty blood from the testis (egg). We can compare the abnormal vasodilation-varicose seen in the legs, which is widely known among the people, to the varicocele in the testicles.

As a result, the dirty blood accumulated in the testicles causes an increase in temperature and the waste products in this blood blood cause deterioration in testicular functions. As a result, pain or discomfort in the groin may cause reduction in the size of the affected testis, softening, deterioration in sperm values and a decrease in male hormone levels.


Its incidence in adult males is approximately 15%. In other words, varicocele is detected in approximately one out of every 7 adult males. In 25% of men with impaired sperm values, varicocele is the cause. The cause is varicocele in approximately 1 out of every 3 men who cannot have children, and in 80% of men who have had children before but cannot have children again.

There is no clear information about why it occurs. However, it is known that varicocele can occur in situations such as standing for a long time, straining, straining. It has been shown that the valves in the veins are problematic.

How Does Varicocele Damage The Testicle?

Damage to the testis occurs for two main reasons: temperature rise and accumulation of toxic products by reverse blood flow.

The increase in temperature negatively affects both sperm and androgen (male hormone) production.

Toxic products from the kidney and adrenal gland also negatively affect sperm production.

Varicocele not only negatively affects sperm count and movement, but also causes sperm DNA damage.

It is known that the underlying problem is DNA damage in men who have a varicocele but cannot have a child with normal sperm count and motility.

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Why Is Varicocele More Common On The Left Side?

Varicocele is seen on the left side with a rate of 75-95%. It is seen bilaterally in 10% of patients and on the right side in 2% of patients. The vein carrying the dirty blood of the left testicle moves upwards from the groin and mixes with the renal vein. On the right side, it joins the main vein that carries the whole body blood to the heart. In the vein that joins the renal vein at right angles to the left side, the blood flow slows down and there is a backward flow. Again, the left side veins are 8-10 cm longer than the right side. In particular, toxic products coming from the adrenal gland with reverse current also contribute to the damage to the testis.

More detailed evaluation may be required in patients with varicocele only on the right side. Causes of pressure on testicular vessels in the kidney or posterior abdominal wall should be investigated.

What Kind of Complaints Does Varicocele Make, What Are The Symptoms?

Most patients are asymptomatic or unaware of the condition.

It is usually detected in the examinations of infertile men or during urology examination for another reason.

Apart from this, when asked to the patients, they describe pain radiating to the testicles-groin especially when they stand for a long time or do sports.

Again, sagging of the testis, the appearance of thick enlarged veins around it, shrinkage and softening of the testis are among the symptoms we see frequently.

How Is It Diagnosed?

Patients usually present with a fullness or pain in their ovaries. In the physical examination, the testicles are examined. On examination, varicocele is divided into degrees according to its severity: In 1st degree varicocele, the enlargement of the testicular vessels is detected by straining (valsalva). Vein width can be felt without manual straining at the 2nd degree. Third-degree varicocele is the most severe level and the testicular veins can be enlarged and twisted externally. In addition, testicular dimensions, testicular consistency, sperm channels are examined in detail.

Physical examination is actually sufficient to make a diagnosis. However, in cases where it is difficult to diagnose during the examination, ovarian ultrasonography (scrotal color Doppler ultrasonography) is requested. These conditions are obesity, hydrocele (fluid accumulation around the egg), previous surgery and testicular tenderness.

Spermiogram is the process of examining the semen (semen fluid) that comes out as a result of the patient's ejaculation after 3-5 days of sexual abstinence and non-ejaculation. The number, motility and rate and structural defect of the sperm in the ejaculated semen are investigated. The decision is not made with a single test, but a full evaluation is made with a second test done 2 weeks later. Hormonal research and some genetic tests may be required in patients with severe deterioration in sperm values.

Who Should Be Treated for Varicocele?

First of all, unfortunately, there is no drug treatment for varicocele. Microscopic varicocelectomy surgery is recommended in patients with impaired sperm values, if this situation cannot be explained by a reason other than varicocele. In the investigation of infertile couples, the varicocelectomy operation performed in those with impaired sperm values increases the potential and chance of having children naturally.

Even if sperm parameters are normal, varicocelectomy may be recommended if DNA damage is detected in couples who cannot have children. After varicocelectomy, improvement in sperm values and improvement in sperm DNA damage are observed. Varicocelectomy also increases the chance of success in assisted reproductive methods.

Should Varicocele Caused by Testicular Pain Be Treated?

Varicocele can cause testicular pain that impairs the quality of life, especially in young people and people who work on their feet actively all day long (such as teachers, police officers, clerks). However, this pain resolves in 48-90% of patients after surgery. Due to the high chance of success, surgical treatment is recommended for these patients by providing detailed information in advance.

Varicocele Surgery, Which Method Is More Successful?

Although there are different surgical techniques described so far for varicocele, the method with the highest success and lowest complication is microscopic varicocelectomy. With an incision of approximately 2 cm made in the groin, the veins coming out of the testis are separated and ligated.

With the use of microscopes that help us to see the operation field in more detail, the success of the operation has increased and its complications are minimized. With microscopic varicocelectomy, the arteries feeding the testis, nerves and lymphatic vessels carrying fluid from the testis are preserved and not damaged.

The surgery is an operation that requires fine dexterity and microscope experience in a small area. Surgery is performed under spinal (waist numbing) or general anesthesia.

How is Post-Operative Follow-up Performed?

Patients are discharged in the evening of the same day or the next day. They can take a bath after 48 hours. As the skin is closed with hidden aesthetic sutures, no stitches are required. There may be redness and mild swelling at the wound line for the first few days. After a few days, they can return to light activities and normal life. 4 weeks should be waited for sexual intercourse. Again, heavy exercises should be avoided for 1 month.

The results of the treatment appear in the sperm tests done in the following months. 60-80% improvement is seen in sperm values. Spontaneous pregnancy occurs in 40-60% of patients.

Does the Use of Micro-Doppler Increase the Chances of Success?

In the operation area, it is aimed to separate and connect the damaged veins that take the dirty blood from the testis. Using a microscope, these veins are differentiated from arteries (arteries) and lymphatic vessels. Thanks to the 1.5mm diameter micro-doppler we use, the safety and success of the surgery increase. As is known, the Doppler device shows the blood flow in the arteries and allows us to protect them.

“The information on this page has been prepared to enlighten patients. Please contact our doctor to get comprehensive information about diagnosis and treatment.”

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