What is the treatment for varicocele?

From the Guidelines

Treatment for varicocele should be individualized based on the severity of symptoms, fertility concerns, and presence of palpable varicoceles, with surgical repair through varicocelectomy or percutaneous embolization being the standard approaches for clinically significant cases, as recommended by the most recent guidelines 1. When considering treatment for varicocele, several factors come into play, including the presence of symptoms, impact on fertility, and the presence of palpable varicoceles.

• For mild cases without symptoms, observation with regular monitoring may be sufficient.
• For cases with significant symptoms or fertility concerns, treatment options include:
  • Surgical repair through varicocelectomy, which can be performed through open surgery, laparoscopic surgery, or microsurgery, with microsurgical varicocelectomy generally offering the lowest complication rates and highest success.
  • Percutaneous embolization, a non-surgical option where a radiologist inserts a catheter through a neck or groin vein to block blood flow to the varicocele using coils or a sclerosing solution. Pain management before definitive treatment may include non-steroidal anti-inflammatory drugs like ibuprofen (400-600mg every 6-8 hours) or naproxen (250-500mg twice daily), as well as supportive measures such as wearing snug underwear, applying ice when needed, and avoiding heavy lifting to manage discomfort, as suggested by previous studies 1. It's crucial to note that treatment of non-palpable varicoceles is not associated with improvement in either semen parameters or fertility rates, whereas correction of palpable varicoceles can result in improvement in both semen quality and fertility, highlighting the importance of proper diagnosis and treatment planning, as emphasized in the latest updates to male infertility guidelines 1.

From the Research

Treatment Options for Varicocele

The treatment for varicocele can vary depending on the individual case and the underlying cause of the condition. Some of the treatment options include:

• Surgical repair: This can be done through an open or microsurgical approach, laparoscopy, or percutaneous embolization of the internal spermatic vein 2.
• Percutaneous embolization: This technique offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts, but it demands interventional radiologic expertise and has potential serious complications 2.
• Microsurgical varicocelectomy: This is recognized as the gold-standard approach for varicocelectomy, due to high success rates with minimal complications 3.
• Laparoscopy: This is often used for bilateral varicoceles and is considered the treatment of choice for this condition 4.
• Open surgery: This is still used for isolated right-sided varicoceles and in left-sided cases with failed sclerotherapy 4.
• Sclerotherapy: This is best used for isolated left-sided varicoceles and has a success rate of 82.8% for left varicoceles and 51% for right varicoceles 4.

Indications for Treatment

The indications for treatment of varicocele include:

• Palpable varicocele(s) with one or more abnormal semen parameters 3.
• Low serum testosterone 3.
• Testicular pain 3.
• Testicular hypotrophy 3.
• Poor sperm DNA quality 3.
• Infertility or subfertility 4, 3, 5.

Outcomes and Complications

The outcomes and complications of varicocele treatment can vary depending on the technique used. Some of the potential complications include:

• Vascular perforation 2.
• Coil migration 2.
• Thrombosis of pampiniform plexus 2.
• Postoperative complications such as infection, bleeding, and recurrence 4.
• The recurrence rate can increase progressively with the increase of varicocele size from grade I to grade III 4.