Varicocele
| Varicocele | |
|---|---|
| Varicocele on the left side. Notice the swelling of the scrotum due to enlarged veins (arrow), while the left testicle itself may be smaller (atrophied) than the right. | |
| Specialty | Urology, Andrology, Interventional radiology |
| Symptoms | Scrotal swelling, dull ache, feeling of heaviness, visible "bag of worms" |
| Complications | Infertility, testicular atrophy, low testosterone |
| Usual onset | Puberty or young adulthood |
| Duration | Chronic (progressive) |
| Causes | Valvular incompetence, Nutcracker syndrome |
| Diagnostic method | Physical examination (Valsalva), Scrotal ultrasound |
| Differential diagnosis | Hydrocele, spermatocele, epididymitis |
| Treatment | Observation, Varicocelectomy (microsurgical), Percutaneous embolization |
| Medication | NSAIDs (for pain management) |
| Frequency | 15% of adult males |
A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. In males, this plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis.
Many varicoceles are asymptomatic, but some cause a dull ache or a feeling of heaviness in the scrotum. Varicoceles are the most common correctable cause of male infertility, found in approximately 35–44% of men with primary infertility. They are also increasingly recognized as a cause of reduced testicular endocrine function, including lower testosterone levels (hypogonadism). Varicoceles occur in around 15% of all men.