Treatment Options for Testicular Varicocele
Microsurgical varicocelectomy is the gold standard treatment for testicular varicocele in men with clinical varicoceles and abnormal semen parameters to improve fertility outcomes. 1, 2
Indications for Treatment
- Treatment is recommended for men with clinical (palpable) varicoceles and abnormal semen parameters to improve fertility rates 1, 2
- Surgery is strongly recommended for varicocele associated with a persistent small testis (size difference >2 mL or 20%), confirmed on two subsequent visits 6 months apart 1
- Treatment may be considered for men with non-obstructive azoospermia (NOA) and a clinically significant varicocele, particularly those with hypospermatogenesis 1, 3
- Treatment is indicated for patients with varicocele-associated pain, typically described as dull, aching, or throbbing pain in the testicle, scrotum, or groin 4
Treatment Options
Surgical Approaches
- Microsurgical inguinal or subinguinal varicocelectomy: Considered the gold standard with superior outcomes and low complication rates 5, 6
- Laparoscopic varicocelectomy: More commonly used in adolescents than adults 7, 8
- Open surgical repair: Traditional approach but has higher complication rates than microsurgical techniques 5
Radiologic Interventions
- Retrograde embolization: Minimally invasive option performed by interventional radiologists 6
- Antegrade scrotal sclerotherapy: Alternative radiologic approach for varicocele treatment 6
Expected Outcomes
- Improvements in semen parameters typically take 3-6 months (two spermatogenic cycles) after varicocelectomy 1, 2, 3
- Spontaneous pregnancy typically occurs between 6-12 months after varicocelectomy in couples with fertility issues 2
- Approximately 80% of patients with varicocele-associated pain experience resolution after varicocelectomy 4
- Severe varicoceles show greater improvement in sperm count after surgical repair compared to moderate or mild varicoceles 2
Important Considerations and Caveats
- Treatment of subclinical (non-palpable) varicoceles is not effective and is not recommended 1, 2, 3
- Routine use of ultrasonography to identify non-palpable varicoceles is discouraged 1, 2
- Special consideration should be given to couples with a female partner with limited ovarian reserve, as time spent waiting for sperm recovery may impact overall fertility outcomes 1, 3
- While varicoceles are present in 15% of the general male population, they are found in 35-40% of men presenting with infertility, indicating a significant association 1, 2
- Only 20% of men with a documented varicocele will suffer from fertility problems, making patient selection for treatment crucial 7
- For adolescents with varicocele, a testicular size discrepancy of more than 20% is a helpful criterion for treatment decisions 8