From the Guidelines
Varicoceles do not always require treatment, and the decision to treat should be based on the presence of symptoms, infertility, or testicular growth arrest, as well as the results of semen analysis and other diagnostic tests, as recommended by the most recent guidelines 1.
Indications for Treatment
The treatment of varicoceles is typically recommended for men with:
- Symptomatic varicoceles, such as those causing pain or testicular atrophy
- Infertility, particularly if the varicocele is palpable and there is evidence of abnormal semen parameters
- Testicular growth arrest in adolescents
Diagnostic Evaluation
The diagnostic evaluation of varicoceles should include:
- Physical examination to assess for palpable varicoceles
- Semen analysis to evaluate semen parameters, such as volume, sperm concentration, and motility
- Scrotal ultrasound to confirm the presence of varicocele and assess testicular size and morphology
Treatment Options
Treatment options for varicoceles include:
- Surgical repair (varicocelectomy) via open inguinal, laparoscopic, or microsurgical techniques
- Non-surgical interventions, such as percutaneous embolization
- These procedures aim to ligate or block the affected veins to redirect blood flow and improve semen parameters and fertility
Outcomes and Recommendations
The outcomes of varicocele treatment include:
- Pain relief in 70-90% of cases
- Fertility improvement in 40-60% of cases
- The most recent guidelines recommend that treatment of varicoceles should be individualized based on the patient's symptoms, semen analysis results, and other diagnostic tests, and that asymptomatic varicoceles without complications can be monitored rather than treated 1. Some key points to consider when evaluating and treating varicoceles include:
- The routine use of ultrasonography to identify non-palpable varicoceles is discouraged, as treatment of these varicoceles is not helpful 1
- Abdominal imaging should not be routinely performed for men with an isolated small or moderate right varicocele, but may be considered for men with a new onset or non-reducible varicocele, especially if the varicocele is large 1
- TRUS evaluation should be considered for men with low ejaculate volume, acidic semen, or other signs of distal male genital tract obstruction 1
From the Research
Treatment of Varicocele
- Varicocele is a condition that requires treatment in certain cases, such as when it causes testicular atrophy, impaired sperm production, or decreased Leydig cell function 2.
- The mainstay of treatment for varicocele is surgical correction, which can be performed through open surgery, laparoscopy, or percutaneous embolization of the internal spermatic vein 3, 4.
- The choice of treatment depends on various factors, including the size and location of the varicocele, as well as the patient's overall health and fertility status 3, 5.
Indications for Treatment
- Treatment is often recommended for patients with palpable varicoceles and abnormal semen parameters, as well as for those experiencing testicular pain, testicular hypotrophy, or poor sperm DNA quality 6.
- In adolescents, treatment is often recommended to prevent potential long-term effects on fertility and testicular function 2.
- However, not all varicoceles require treatment, and the decision to treat should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances 2.
Treatment Outcomes
- Studies have shown that treatment of varicocele can improve semen parameters, reduce testicular pain, and improve fertility outcomes 3, 5.
- Percutaneous embolization of the internal spermatic vein has been shown to be a effective and minimally invasive treatment option, with high success rates and low complication rates 4, 5.
- Microsurgical varicocelectomy is also a highly effective treatment option, with high success rates and minimal complications 6.