A varicocele is a varicose vein(s) involving the veins that drain the testicles/scrotum. They result from the same mechanism that causes varicose veins in other parts of the body. The venous dilatation comes from venous hypertension exacerbated by gravity causing incompetent veins. This changes the direction of venous blood flow from towards the heart (away from the scrotum) to towards the scrotum. The venous blood pools in the these dilated scrotal varices, which raises the temperature of the scrotum and can lead to diminished sperm counts.
Varicoceles are a leading cause of male infertility and they may be treated for this or for the pain and discomfort that they can cause. They can be treated also to prevent testicular atrophy in young men. There are two general types of treatment: non-surgical (percutaneous) with an interventional radiologist or surgical with a urologic surgeon.
The percutaneous approach has a higher success rate. It is performed as an outpatient with a 1-2 day recovery. The approach is either from the groin (right femoral) or neck (right jugular). A catheter is placed into the spermatic veins that drain the venous blood from the scrotum. Varicoceles are most commonly left-sided only but they can be bilateral. A "sandwich" of 2 nests of coils with liquid/foam sclerosant in between is the most common technique. The sclerosant is the same that is used for varicose veins elsewhere in the body. This sclerosant can get in to the numerous collateral venous channels that are often present in order to obliterate them, and explains why the recurrence rate is lower with this approach over the traditional surgical approach.
The traditional surgical approach is the open inguinal varicocelectomy. Other surgical approaches include retroperitoneal and subinguinal. Some centers are doing this procedure laparoscopically as well. The veins draining the scrotum are ligated but the collateral channels are often above the surgical site, which again accounts for the higher recurrence rate.
More Answers from John Lipman, MD