A varicocele is like getting varicose veins in your legs when the veins inside your scrotum become enlarged. 10 to 15 percent of males have a varicocele.

What is the normal anatomy?

The male reproductive system makes, stores, and moves sperm. The scrotum is the sac of skin that holds the testicles. Sperm and the hormone testosterone are made in the testicles. Sperm travel to the prostate from each testicle using tubes called epididymis and the vas deferens. When you ejaculate, seminal fluid mixes with sperm in the prostate to form semen. The semen travels through the urethra and comes out the end of your penis.

The spermatic cord holds the vas deferens and the testicular artery, which brings blood to the testicle. It also houses the pampiniform plexus, a group of connected veins that drains the blood from the testicles. The pampiniform plexus cools blood in the testicular artery before it enters the testicles. This helps keep it at the temperature needed to make sperm.

What are Varicoceles?

Varicoceles are when the pampiniform plexus veins in the scrotum become enlarged. These veins are like varicose veins in the leg. Varicoceles form during puberty, and can grow larger and easier to notice over time. Varicoceles are more common on the left side of the scrotum.

Most of the time, varicoceles cause no problems and are harmless. Sometimes, the varicoceles can cause pain, infertility (problems fathering a child) or 1 testicle to grow slower or shrink.

How are varicoceles diagnosed?

Varicoceles are found through self-exam of the scrotum or during a routine doctor’s exam. They are typically described as a “bag of worms” because of how they look and feel.

Your GP or urologist may organize an ultrasound scan of the scrotum to confirm the size of the veins and to assess the size of the testicles.

What are the treatment options?

There is no medication that can treat varicocele although pain killers may help with the discomfort associated with varicocele.

The two most common treatment options are:

1. Surgery: Common surgical approaches are retroperitoneal (abdominal using laparoscopic surgery), infrainguinal/subinguinal (below the groin) and inguinal (groin using percutaneous embolization). Possible complications of this procedure include hematoma (bleeding into tissues), hydrocele (accumulation of fluid around the affected testicle), infection, or injury to the scrotal tissue or structures. In addition, injury to the artery that supplies the testicle may occur, resulting in a loss of a testicle.
2. Varicocele Embolisation: This is a specialist procedure performed by an interventional radiologist. it can be done as a day case procedure through a small (about 2mm) incision in the neck. The procedure is done under local anaesthetic and you are back to routine activities in a few hours.