From the Guidelines
The treatment approach for testicular varicocele should be guided by the presence of symptoms and fertility concerns, with treatment typically recommended for men with pain, testicular atrophy, or infertility with abnormal semen parameters, as indicated by the most recent guidelines 1.
Treatment Approach
The treatment of testicular varicocele depends on several factors, including the presence of symptoms, fertility concerns, and the severity of the varicocele.
- For asymptomatic varicoceles without fertility issues, observation is often recommended with regular monitoring.
- When treatment is indicated, surgical repair through varicocelectomy is the standard approach, with microsurgical subinguinal or inguinal techniques preferred due to lower complication rates and better outcomes.
- Percutaneous embolization offers a less invasive alternative where interventional radiologists occlude the affected veins.
Rationale for Treatment
The rationale for treatment is to eliminate venous reflux, reduce testicular temperature, and improve testicular function.
- Treatment is typically recommended for men with pain, testicular atrophy, or infertility with abnormal semen parameters, as supported by recent studies 1.
- The use of scrotal ultrasound can be useful in confirming the presence of varicocele and assessing treatment success, as suggested by guidelines 1.
Post-Procedure Care
Post-procedure, patients usually require minimal pain management with over-the-counter medications like acetaminophen or ibuprofen for 1-2 days.
- Most men can return to light activities within 24-48 hours and resume normal activities, including exercise, within 1-2 weeks after surgical repair.
- Follow-up evaluation at 3-6 months is important to assess treatment success and semen parameters in cases of infertility, as recommended by recent guidelines 1.
From the Research
Treatment Approaches for Testicular Varicocele
The treatment for testicular varicocele involves several options, including:
- Open varicocelectomy performed at various anatomical levels 2
- Laparoscopic varicocelectomy, which has been established as a safe and effective treatment for varicoceles 2, 3
- Robotic surgery, introduced as an 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
- Minimal invasive varicocele treatment with percutaneous retrograde and anterograde venous embolization/sclerotherapy 2, 4, 5, 6
Percutaneous Embolization
Percutaneous embolization of the internal spermatic vein is a treatment option that offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts 4. However, this technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus 4.
Sclerotherapy
Antegrade scrotal sclerotherapy has been used to treat patients with varicocele since 1987, with a success rate of 91% in a follow-up study of 285 patients 5. Percutaneous sclerotherapy has also been reported to be simple and effective, with low morbidity and only three failures in a study of 89 patients 6.
Surgical Correction
Surgical correction is the mainstay of treatment for varicocele in adolescents and adults, with the goal of eliminating varicocele, preserving testicular function, and increasing semen quality and the likelihood of pregnancy 2, 3. The choice of surgical approach, including open, laparoscopic, or microsurgical varicocelectomy, depends on various factors, including the patient's age, symptoms, and fertility status 2, 3.