Varicocele: Symptoms, Treatment, and Risks Explained

Varicocele

Hello, Dr.
Hsu.
A few days ago, I noticed discomfort in my right testicle, accompanied by a sensation of heat, which made it uncomfortable for me to sleep at night.
After two days, I went to see a urologist, who immediately diagnosed me with varicocele.
I thought this condition typically occurs on the left side and is associated with prolonged standing.
However, my discomfort is on the right side, and it occurs when I am sitting or lying down.
The doctor mentioned that surgery is the only solution and prescribed some anti-inflammatory medication, but I haven't experienced any improvement.
I feel like my right testicle is still warm and uncomfortable throughout the day.
I researched online and found that if there is no pain, surgery might not be necessary.
Is that true? Additionally, will surgery increase the risk of infertility or cause any changes or impacts on my testicles or sexual activity? Lastly, if the scrotum remains warm and the veins are swollen for an extended period, could that lead to testicular damage? Thank you.

Xiao Qiang, 20~29 year old female. Ask Date: 2006/08/28

Dr. Xu Weikai reply Urology

Hello, it is uncommon for this condition to occur on the right side.
When it does happen on the right side, a more detailed examination is necessary to check for factors such as tumors in the internal organs that may be compressing the blood vessels.
Surgery is performed to save the testicle and enhance its function.
Generally, if there is no pain and it does not affect the quality of the semen, it can be disregarded.
This is a response from Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2006/08/28

More Info

Varicocele is a condition characterized by the enlargement of veins within the scrotum, similar to varicose veins that can occur in the legs. It is most commonly found on the left side due to anatomical differences in venous drainage, but it can also occur on the right side, as in your case. Symptoms of varicocele can include discomfort or a feeling of heaviness in the scrotum, particularly after prolonged standing or physical activity. In some cases, it may lead to complications such as infertility.

Symptoms of Varicocele
The symptoms you are experiencing, such as discomfort and a sensation of heat in the right testicle, are not uncommon. While varicocele is typically associated with the left side, the right-sided occurrence can happen and is often due to anatomical variations. Symptoms can vary, and some individuals may not experience any discomfort at all.

Treatment Options
The primary treatment for varicocele is surgical intervention, especially if the condition is causing significant discomfort or is associated with infertility. The surgical options include:
1. Varicocelectomy: This is the surgical removal of the affected veins. It is typically performed under general anesthesia and can be done through an open surgery or laparoscopically.

2. Embolization: A less invasive procedure where a catheter is used to block the affected veins, redirecting blood flow to healthier veins.

While you mentioned that your doctor prescribed anti-inflammatory medications, these may help alleviate some discomfort but will not resolve the underlying issue of the varicocele.

Risks and Concerns
Regarding your concerns about surgery, it is important to note that while varicocele surgery is generally safe, like any surgical procedure, it carries risks. These can include:
- Infection
- Bleeding
- Injury to surrounding structures
- Recurrence of varicocele
As for the impact on fertility, studies have shown that varicocele can affect sperm production and quality. Surgical correction has been associated with improved fertility outcomes in men with varicocele-related infertility. However, if you are not currently experiencing fertility issues, the decision to undergo surgery may depend on the severity of your symptoms and your personal circumstances.

Long-term Effects
If left untreated, a varicocele can potentially lead to complications such as testicular atrophy (shrinkage) or infertility. The prolonged heat and swelling in the scrotum can affect testicular function, as the testicles require a cooler environment for optimal sperm production. If you are experiencing persistent discomfort, it is advisable to follow up with your urologist for further evaluation and to discuss your treatment options.

Conclusion
In summary, while varicocele is often asymptomatic and may not require treatment if it does not cause discomfort or fertility issues, your symptoms warrant further investigation. Surgical options are available and can provide relief and improve fertility outcomes if necessary. It is crucial to maintain open communication with your healthcare provider about your symptoms and concerns, as they can guide you in making the best decision for your health. If you continue to experience discomfort or have concerns about the potential for complications, seeking a second opinion or further evaluation may be beneficial.

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