From the Guidelines
Varicoceles often cause no symptoms, but when they do, the most common is a dull, aching pain or heaviness in the scrotum that worsens with standing, physical exertion, or at the end of the day, as reported in the most recent guideline by the American Urological Association and the American Society for Reproductive Medicine 1.
Common Symptoms
- A dull, aching pain or heaviness in the scrotum
- A dragging sensation or visible swelling in the scrotum
- The affected testicle may appear smaller than the other one due to potential atrophy from impaired blood flow
- Visible or palpable enlarged, twisted veins above the testicle, often described as feeling like a "bag of worms"
- Fertility problems can be another symptom, as the increased temperature in the scrotum from pooled blood can affect sperm production
Diagnostic Approach
According to the guideline, clinicians should not perform transrectal ultrasonography (TRUS) or pelvic MRI as part of the initial evaluation of the infertile male, unless there is a suspicion of ejaculatory duct obstruction (EDO) 1.
Treatment
Treatment is typically recommended only when symptoms are bothersome or when fertility is affected, and may include surgical repair or embolization procedures to redirect blood flow away from the affected veins, as suggested by the American Urological Association and the American Society for Reproductive Medicine 1. In cases where varicocele is suspected to be causing infertility, treatment may be offered to the male partner of an infertile couple when there is evidence of abnormal semen parameters and minimal/no identified female factor, including consideration of age and ovarian reserve 1. It is essential to note that the routine use of ultrasonography to identify clinical (non-palpable) varicocele is discouraged, as treatment of these varicoceles is not helpful, as stated in the guideline by the American Urological Association and the American Society for Reproductive Medicine 1. If you experience sudden, severe pain, seek immediate medical attention as this could indicate a different condition requiring urgent care.
From the Research
Varicocele Symptoms
The provided studies do not directly discuss varicocele symptoms. However, they do mention the effects of varicoceles on male reproduction and the various treatment options available.
Treatment Options
- Open varicocelectomy performed at various anatomical levels 2
- Laparoscopic varicocelectomy, which is a safe and effective treatment for varicoceles 2
- Robotic surgery, a recently introduced alternative surgical option for varicocelectomy 2
- Microsurgical varicocelectomy, which has gained popularity among experts in male reproductive medicine due to its superior surgical outcomes 2, 3
- Percutaneous retrograde and anterograde venous embolization/sclerotherapy, a minimal invasive varicocele treatment 2, 4