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Treatments and drugs
By Mayo Clinic staffVaricocele treatment may not be necessary. However, if your varicocele causes pain, testicular atrophy or infertility, you may want to undergo varicocele repair. The purpose of surgery is to seal off the affected vein to redirect the blood flow into normal veins. However, the effect of varicocele repair on fertility is unclear.
Although varicoceles typically develop in adolescence, it's less clear whether you should have varicocele repair at that time. Indications for repairing a varicocele in adolescence include progressive testicular atrophy, pain or abnormal semen analysis results.
Varicocele repair presents relatively few risks. They include:
- Buildup of fluid around the testicles (hydrocele)
- Recurrence of varicoceles
- Damage to an artery
Repair methods include:
-
Open surgery. This most common form of treatment usually is done on an outpatient basis, using general anesthetic or local anesthetic. Most commonly, your surgeon will approach the vein through your groin (transinguinal), but it's also possible to make an incision in your abdomen or below your groin.
Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.
You may be able to return to normal, nonstrenous activities after two days. As long as you're not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.
Pain from this surgery generally is mild. Your doctor may prescribe pain medication for the first two days after surgery. After that, your doctor may advise you to take over-the-counter (OTC) painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to relieve discomfort.
Your doctor may advise you not to have sexual intercourse for one week. It takes about 72 days for sperm to generate, so you'll have to wait three or four months after surgery to get a semen analysis to determine whether the varicocele repair was successful in restoring your fertility.
- Laparoscopic surgery. Your surgeon makes a small incision in your abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. However, this procedure, which requires general anesthetic, isn't used commonly because it poses more risk while offering little advantage.
- Percutaneous embolization. A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or balloons to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure uses sedation and may take several hours. This procedure isn't widely used because it presents greater risks than does open surgery and offers little advantage.
- Varicoceles. American Urological Association. http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=510. Accessed Oct. 6, 2009.
- Richardson I, et al. Outcomes of varicocelectomy treatment: An updated critical analysis. Urological Clinics of North America. 2008;35:191.
- Patient fact sheet: Varicocele. American Society for Reproductive Medicine. www.asrm.org/Patients/FactSheets/Varicocele.pdf. Accessed Oct. 6, 2009.
- Report on varicocele and infertility. American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/varicoceleinfertility.pdf. Accessed Oct. 6. 2009.
- Khera M, et al. Evolving approach to the varicocele. Urological Clinics of North America. 2008;35:183.
