What Is a Varicocele and Why Is It Important?

A varicocele is the enlargement of the veins that carry deoxygenated blood away from the testicles. It is similar to varicose veins seen in the legs, but in this case, it occurs around the testicles. It is the most common and treatable cause of male infertility.

Approximately 15% of men in the general population have varicocele; among couples who are unable to conceive, this rate rises to as high as 40%. While some men seek medical attention due to a sensation of fullness, pain, or warmth in their testicles, others are diagnosed with varicocele only after low sperm count is detected in a semen analysis.

Prof. Dr. Volkan İzolsummarizes the importance of varicocele as follows:

“Varicocele is the most common cause of male infertility that we see, and it can be corrected with surgery. With proper patient selection and microsurgery, the chances of success are very high.”

What Causes Varicocele?

The most common cause of varicocele is a malfunction of the valves in the veins leading from the testicle to the heart. In this condition, blood flows backward, and the veins dilate.

Risk factors:

  • Genetic predisposition
  • Standing for a long time
  • Doing heavy physical work
  • Increased intra-abdominal pressure (constipation, chronic cough)

This condition leads to an increase in testicular temperature, the accumulation of toxic substances, and impaired sperm production.

Symptoms of Varicocele

Not every varicocele causes symptoms. However, you should see a doctor if you have the following symptoms:

  • Fullness and swelling in the scrotum
  • Testicular pain that worsens, especially in the evenings
  • Testicular shrinkage (atrophy)
  • Inability to have children
  • Low sperm count or low motility in a semen analysis

Varicocele usually occurs on the left side, but it can also be bilateral.

Diagnostic Methods

Physical Examination

During a physical examination while the patient is standing, the dilated veins feel like a “clump of worms.”

Ultrasound (Doppler)

It measures blood vessel diameters and indicates whether reflux (backflow) is present.

The diagnosis is usually made through a physical examination; ultrasound is used for confirmatory purposes.

 

Varicocele Treatment

Treatment is not necessary for every patient. It is recommended only in the following cases:

  • If an abnormality is detected in the semen analysis
  • If there is a decrease in testicular volume
  • If it hurts
  • Unless there are other underlying causes in couples who wish to have children,

Microsurgical Varicocele Surgery

Today, the gold standard of treatmentis microsurgical varicocelectomy.

How to Do It?

  • A small incision, 2–3 cm long, is made in the groin area.
  • Under a surgical microscope, the dilated blood vessels are tied off one by one.
  • The lymphatic vessels and the testicular artery are preserved.

Advantages:

  • Lowest risk of recurrence (approximately 1–2%)
  • The risk of hydrocele (fluid buildup in the scrotum) is lowest
  • More Accurate Vessel Identification Under a Microscope
  • Patients can be discharged the same day

Prof. Dr. Volkan İzol, an experienced surgeon who performs microsurgery, emphasizes the following point:

“Microsurgery is the gold standard for varicocele treatment. The success rate is very high, and the complication rate is extremely low.”

Other Treatment Options

  • Open Surgery (Palomo Technique):Performed without a microscope; the risk of recurrence is higher.
  • Laparoscopic Surgery:The veins are clipped through an incision in the abdomen. The advantage is that it is easier to perform in cases of bilateral varicose veins.
  • Embolization:The blood vessel is blocked using an interventional radiology procedure. The risk of recurrence is higher.

Postoperative Care and Discharge

  • Patients are usually discharged the same day or the next day.
  • You can return to your normal daily routine within one week.
  • Strenuous physical activities should be postponed for 2–3 weeks.
  • Improvements in sperm parameters are observed after 3–6 months.

Side Effects

The side effectsof microsurgical varicocele surgery are quite rare:

  • Mild swelling and bruising
  • Rarely, a hydrocele
  • Revascularization occurs very rarely

Varicocele and Infertility

Varicocele makes it difficult to have children by impairing sperm count and motility. After surgery:

  • Sperm motility increases
  • Fertility increases
  • Pregnancy rates increase significantly

For this reason, varicocele treatment is an important step for couples who wish to have children.

Prof. Dr. Volkan İzol’s Approach

Prof. Dr. Volkan İzol is a professor of urology who successfully performs microsurgical varicocele procedures in Adana. He offers his patients personalized treatment plans and explains the pre- and post-operative processes in detail.

Conclusion

Varicocele is the most common treatable cause of male infertility. Microsurgical varicocele surgery both preserves testicular function and improves sperm quality. Early diagnosis and the right surgical technique increase a couple’s chances of conceiving naturally.