Varicocele: do you need surgery? Fertility, pain and treatment options

Not every varicocele needs an operation. So how do you know if yours does? Let me show you what the European guidelines actually say about it.

So a varicocele is nothing more than a group of swollen and dilated veins above and around the testicle that are not working quite well. The flow goes in the wrong direction and what should go from the testicle to above actually goes in the other way around, at least in certain conditions. This leads to increased temperature, increased amount of toxins around the testicle, and can create reduced quality of the semen, or pain, or both. To be clear, varicocele is incredibly frequent in the young population of men and in most of the cases you might simply not even know you have one and you can be perfectly fertile and without any form of pain still having a varicocele.

Let's start with when not to operate.

If you have no pain, your semen test is normal, the guidelines would say not to operate. Also, if the varicocele can only be seen by Doppler ultrasound scans, so it's not clinically felt, the same rule applies not good to consider an operation, because the conduct of operating adds some risk, the perioperative and postoperative risk, without demonstrating any clear benefit.

But there are three situations where treating the varicocele can make sense. The first is that you are trying for a baby, that you have a varicocele normally on the left hand side, that this varicocele can be felt, your semen test is showing abnormalities, your partner fertility have been checked and it is normal. In that case, operating the varicocele can be a way of increasing the semen quality, and that has been widely demonstrated. Two, when the varicocele is causing pain and treating the varicocele can improve the pain. The third case where operation of the varicocele is recommended is in teenagers when one of the testicles where the varicocele is is sensibly smaller than the other testicle by more than two milliliters, on at least two checks, at least six months apart.

So if you do need the treatment, the technique that is used matters. There are published studies that are the ground for the most recent guidelines in the European Association of Urology.

The varicocele is back in about four patients out of a thousand of men that had microsurgical ligation of the varicocele, compared with three to six out of a hundred after laparoscopic surgery, and in three to 11 out of a hundred after embolisation.

Microsurgery is the technique I usually offer. Of course, keyhole surgery and embolisation, they do have their own advantages, and I'm always happy to discuss each and every technique in the finest detail before taking a decision.

For couples undergoing assisted conception, that means ICSI or any IVF technique, repairing a varicocele that needs it has been linked to better chances of pregnancies and better chances of a live birth. As always with fertility it may improve the odds but is never a guarantee. For varicocele the first step isn't surgery it is the right test, an examination, a semen analysis and most of the times a scrotal ultrasound with colour Doppler evaluation. If you'd like to know which group you're in you need to book an assessment in a specialised centre and if you want to give your contribution and your comments, please write them down in the comment section and do not forget to subscribe to the channel if you found this video useful.