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Treatments and drugs
By Mayo Clinic staffVaricocele treatment may not be necessary. However, if you're infertile or your varicocele causes pain or testicular atrophy, you may want to undergo varicocele repair. Treatment is aimed at sealing off the affected vein to redirect the blood flow into normal veins.
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. Increased fluid around the testicles (hydrocele) occurs in a small percentage of cases. Recurrence of varicoceles is a risk, affecting perhaps one in 10 men who undergo repair. Repair methods include:
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Open surgery. This most common form of treatment usually is done on an outpatient basis, using general or local anesthetic. Your surgeon may approach the vein through your groin (transinguinal), abdomen (retroperitoneal) or below your groin (infrainguinal/infrapubic). Transinguinal surgery is most frequently used.
Recovery after surgical repair usually proceeds rapidly. Your doctor may advise you to return to normal activities that aren't strenuous after two days. As long as you're not uncomfortable, you may return to more strenuous normal activity, such as exercising, after two weeks. Pain resulting from this surgery is generally 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 (Motrin, Advil, 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. With this approach, 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. Again, because of presenting greater risks than open surgery and offering little advantage, this procedure isn't widely used.
