From the Guidelines
Varicoceles should be treated with endovascular therapy embolization, which has been shown to be effective in relieving orchialgia, with 87% of patients having complete pain relief at 39 months, as demonstrated in a review of 154 patients 1. When it comes to the diagnosis and treatment of varicocele, also known as varicose vein in the scrotum, it is essential to consider the impact on fertility and quality of life. Varicoceles affect up to 15% of males and are the most common diagnosis in infertile men 1. The treatment options include surgical methods such as open surgery, laparoscopic surgery, or microsurgery to tie off the affected veins, as well as non-surgical alternatives like embolization performed by interventional radiologists.
Treatment Options
- Endovascular therapy embolization: This method involves blocking blood flow to the varicocele using coils or sclerosants and has been shown to be effective in relieving orchialgia 1.
- Surgical options: Open surgery, laparoscopic surgery, or microsurgery to tie off the affected veins can be considered.
- Pain management: Over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) can help, along with scrotal support and avoiding prolonged standing.
Fertility Considerations
Varicoceles can affect fertility by raising testicular temperature and altering hormone function, so men experiencing infertility with varicoceles should consider treatment 1. The treatment of a clinically palpable varicocele 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. After treatment, improvement in semen quality typically takes 3-6 months, and regular follow-up with a urologist is important to monitor for recurrence or complications.
Key Considerations
- The treating physician’s experience and expertise, including evaluation of both partners, together with the options available, should determine the approach to varicocele treatment 1.
- Significant further research is necessary to guide clinical management, as the current recommendations are based on limited evidence and varying expert opinions 1.
From the Research
Diagnosis of Varicocele
- Varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord 2
- The main clinical indication for recommending repair is testicular atrophy, especially in adolescent males 2
- Semen analysis is an important diagnostic tool for varicocele, as it can help identify impaired sperm production and decreased Leydig cell function 2
Treatment of Varicocele
- Surgical varicocelectomy is a common treatment option for varicocele, with microsurgical ligation of dilated veins being the most preferred technique 3
- Microsurgical varicocelectomy has been shown to improve sperm parameters and increase the chances of successful conception in most patients 3
- Other treatment options include radiographic venous embolization, antegrade sclerotherapy, and laparoscopic varicocelectomy 4, 5
- The choice of treatment depends on the individual patient's condition, with microsurgical techniques being recommended to minimize the risk of recurrence 6
Recurrence of Varicocele
- Recurrence of varicocele can occur in 1-3% of cases after microsurgical varicocelectomy 6
- The main cause of recurrence is the presence of intact gonadal vein branches, which can be identified during repeat microsurgical operations 6
- Repeat microsurgical varicocelectomy or endovascular surgery can be effective in treating recurrent varicocele, with microsurgical techniques being preferred to minimize the risk of further recurrence 6
Considerations for Treatment
- The treatment of varicocele should be individualized, taking into account the patient's symptoms, fertility status, and overall health 3
- The benefits and potential complications of surgical treatment should be discussed with the patient, including the risk of recurrence and the potential impact on fertility 3, 6
- Varicocele correction is a cost-effective therapeutic modality compared to assisted reproductive techniques such as intrauterine insemination (IUI) and in vitro fertilization (IVF) 5