What is the average increase in testicular size after varicocele (varicose vein in the scrotum) repair?

Testicular Volume Increase After Varicocele Repair

Varicocele repair leads to a significant increase in testicular volume, with studies showing an average increase of 1.5 mL in the affected testicle after treatment. 1

Extent of Testicular Volume Improvement

• Testicular volume improvements typically parallel the timeline for semen parameter improvements, taking up to two spermatogenic cycles (approximately 3-6 months) to show enhancement 2
• Studies have demonstrated a statistically significant increase in testicular volume after varicocele treatment (p < 0.05) 3
• The average increase in left testicular volume after repair is approximately 1.5 mL, while total testicular volume (both testes) increases by about 2.4 mL 1

Factors Affecting Volume Recovery

• The severity of varicocele impacts both preoperative testicular volume and the degree of improvement after repair 4
• Men with grade 3 (large) varicoceles typically have lower preoperative testicular volumes but may experience greater relative improvement after repair compared to those with smaller varicoceles 4
• The European Association of Urology strongly recommends surgery for varicocele when associated with a persistent small testis (size difference >2 mL or 20%), confirmed on two subsequent visits 6 months apart 2

Timeline for Volume Recovery

• Testicular volume improvements typically occur within the same timeframe as semen parameter improvements, which take up to two spermatogenic cycles (approximately 3-6 months) 2
• Follow-up studies have shown significant volume increases when measured at an average of one year post-procedure 3
• The timing of surgery may influence outcomes, with earlier intervention potentially preventing permanent testicular damage 2

Clinical Implications

• Testicular volume increase correlates with improvements in semen parameters, including total sperm count and motility 3
• The Spearman correlation coefficient shows a good relationship between testicular volume and total number of spermatozoa (r = .445; p = .01) 3
• Varicocele repair should only be performed in men with clinical varicoceles and abnormal semen parameters, as treatment of subclinical varicoceles or men with normal semen analysis is not recommended 2

Surgical Technique Considerations

• Both artery-sparing techniques and the Palomo procedure (which ligates the testicular artery) have shown similar improvements in testicular volume in adolescents, with mean relative left testicular volume increases of 18% and 21%, respectively 5
• In contrast, a comparison group with uncorrected varicoceles showed only a 3% increase in relative testicular volume over a similar follow-up period 5

Bilateral vs. Unilateral Effects

• In patients with unilateral left varicocele, repair leads to significant improvement in left testicular volume 1
• In patients with bilateral varicoceles (clinical left with subclinical or clinical right), repair of both varicoceles leads to significant improvement in left and total testicular volume 1
• Interestingly, some studies have shown that the right testicle may show a greater increase in volume after repair, regardless of whether the varicocele was unilateral or bilateral 6