Varicocele: Concerns, Surgery, and Fertility Impact

Varicose veins

1.
My left side is more than twice the size of my right side.
I went to the hospital for an examination, and the doctor said it is mild varicose veins, but I feel like it has swollen to twice its size.
Is there a chance it could get bigger?
2.
Also, if the pain is infrequent and only feels strange when sitting, as if there is a large mass below, do I need surgery? Note: I am not married yet, so I am unsure about the impact on fertility.
The doctor advised me to have annual check-ups, but I am always worried it will worsen.
How can I determine the severity of my condition?
3.
If I have surgery, will the left side become smaller and not be so large? It is difficult to sit and stand.
Are there any drawbacks to surgery? Will it recur and return to its original state, or should I wait until after I am married to have the surgery? Thank you for your response, Dr.
Chen.

xin li bu shufu, 20~29 year old female. Ask Date: 2005/07/12

Dr. Chen Xiuyi reply Urology

Hello, in the treatment of varicocele, if there is only mild discomfort, medication can be used to alleviate pain.
However, if the pain is severe or leads to infertility, surgical intervention is recommended.
The surgical options include: retroperitoneal varicocele ligation, inguinal surgery, microscopic high inguinal varicocelectomy, and laparoscopic varicocele ligation.
Each surgical method has its own advantages and disadvantages.
The recurrence rate is approximately 10-15%.
Additionally, based on your description, the left scrotum is more than twice the size of the right, which is relatively uncommon in varicocele patients.
Other possibilities must be considered, such as hernia, hydrocele, cryptorchidism, tumors, or lymphadenitis.
It is best to consult a urologist for evaluation, and if necessary, an ultrasound of the scrotum can be arranged.
Sincerely, Dr.
Chen Hsiu-Yi, Urology.

Reply Date: 2005/07/12

More Info

Varicocele is a condition characterized by the enlargement of veins within the scrotum, similar to varicose veins that occur in the legs. It is a common condition, particularly among men aged 15 to 25, and can have implications for fertility. Your concerns about the size of the varicocele, the associated discomfort, and the potential impact on fertility are valid and warrant a thorough discussion.

1. Size and Progression of Varicocele: You mentioned that the left side appears to be significantly larger than the right. Varicoceles can indeed vary in size, and while some may remain stable, others can progress over time. Factors such as increased pressure in the veins due to physical activity, prolonged sitting, or genetic predisposition can contribute to the enlargement. Regular monitoring, as advised by your doctor, is essential to assess any changes in size or symptoms.

2. Symptoms and Surgical Consideration: The discomfort you experience, particularly when sitting, is not uncommon with varicocele. Many men report a sensation of heaviness or discomfort in the affected area. If the pain is infrequent and manageable, surgery may not be immediately necessary. However, if the discomfort worsens or interferes with your daily activities, surgical intervention might be considered. Surgery for varicocele, known as varicocelectomy, can alleviate symptoms and potentially improve fertility outcomes.

3. Impact on Fertility: Varicocele has been associated with decreased sperm production and quality, which can affect fertility. If you are planning to start a family in the future, addressing the varicocele may be beneficial. Studies suggest that surgical correction can improve sperm parameters in many men, although results can vary. If you are concerned about your fertility, it may be worthwhile to consult a urologist specializing in male reproductive health.

4. Surgical Outcomes and Risks: Regarding your concerns about surgery, varicocelectomy is generally considered safe, with a low complication rate. Most men experience a reduction in the size of the varicocele post-surgery, which can alleviate discomfort. However, there is a possibility of recurrence, where the varicocele may return. This is relatively uncommon but can happen. Discussing the risks and benefits of surgery with your healthcare provider is crucial to making an informed decision.

5. Timing of Surgery: Since you are not currently married and may not be considering fatherhood in the immediate future, the decision to undergo surgery can be influenced by your personal circumstances. If the varicocele is not causing significant discomfort and you are not experiencing fertility issues, you might opt to wait until you are ready to start a family. However, if the varicocele is causing significant discomfort or anxiety, addressing it sooner may improve your quality of life.

In summary, while varicocele can be a source of concern, especially regarding fertility, many men live with this condition without significant issues. Regular check-ups, monitoring symptoms, and discussing your concerns with a healthcare provider can help you manage the situation effectively. If you decide to pursue surgery, it can potentially alleviate discomfort and improve fertility outcomes, but the decision should be based on your current health, lifestyle, and future family plans.

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