Varicocele: Symptoms, Risks, and Treatment Options

Q: Varicocele: Symptoms, Risks, and Treatment Options

Andy： Hello, surgery is the only option that may allow the testicles to regain function. <br>Without surgery, the condition may worsen. <br>If there are any unclear points, feel free to ask again, and we can discuss and research further. <br>Answers found online should only be us

Varicocele

Hello, Dr.
Hsu: I have been experiencing intermittent discomfort in my left scrotum for many years.
Recently, due to an increase in the frequency of symptoms, I consulted a physician who diagnosed me with bilateral varicocele, with the left side being more severe and already showing signs of testicular atrophy.
The physician mentioned that I should think about whether to proceed with surgery.
I have not yet checked my sperm quality, but given the atrophy, is surgery a better option? If I choose not to have surgery, will the atrophy condition gradually worsen?

Andy, 30~39 year old female. Ask Date: 2016/02/12

Dr. Xu Weikai reply Urology

Andy: Hello, surgery is the only option that may allow the testicles to regain function.
Without surgery, the condition may worsen.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Answers found online should only be used as a reference; if necessary, it is important to seek medical care at a healthcare facility.
This message is from Dr.
Hsu Wei-Kai, Director of the Urology Department at Taitung Hospital, Ministry of Health and Welfare, who cares about you.

Reply Date: 2016/02/12

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 a common condition, particularly among men aged 15 to 25, and can lead to various symptoms and complications, including testicular atrophy (shrinkage) and infertility.

Symptoms of Varicocele
The primary symptoms of varicocele can include:
1. Dull, aching pain: This is often described as a feeling of heaviness or discomfort in the scrotum, particularly after prolonged standing or physical activity.

2. Visible or palpable veins: Enlarged veins may be visible or can be felt as a "bag of worms" in the scrotum.

3. Testicular atrophy: As you mentioned, varicocele can lead to shrinkage of the affected testicle, which is often more pronounced on the side of the varicocele.

4. Infertility: Varicocele is associated with decreased sperm production and quality, which can lead to difficulties in conceiving.

Risks Associated with Varicocele
The main risks of untreated varicocele include:
- Infertility: Studies have shown that varicocele can negatively impact sperm production and quality, leading to infertility in some men.

- Testicular atrophy: As you have experienced, prolonged varicocele can lead to shrinkage of the testicle, which may be irreversible.

- Hormonal imbalances: Varicocele can affect testosterone levels, potentially leading to hormonal issues.

Treatment Options
When considering treatment for varicocele, several options are available:
1. Observation: If the varicocele is asymptomatic and not affecting fertility, a "watchful waiting" approach may be recommended. Regular follow-ups can help monitor any changes in symptoms or testicular size.

2. Surgical intervention: If the varicocele is causing significant symptoms, testicular atrophy, or infertility, surgical treatment may be indicated. The most common surgical procedures include:
- Varicocelectomy: This is the surgical removal of the affected veins. It can be performed through an open surgery or laparoscopically. This procedure has been shown to improve sperm quality and may reverse testicular atrophy.

- Embolization: A less invasive procedure where a catheter is used to block the blood flow to the enlarged veins, leading to their shrinkage.

3. Assisted reproductive techniques: If fertility is a concern and surgery is not an option, assisted reproductive technologies such as in vitro fertilization (IVF) may be considered.

Decision-Making
Given your situation of experiencing testicular atrophy and increased symptoms, it is crucial to weigh the benefits of surgical intervention against the risks of continued observation. If left untreated, the atrophy may worsen, potentially leading to more significant fertility issues. Consulting with a urologist who specializes in male reproductive health can provide you with a comprehensive evaluation of your sperm quality and help guide your decision regarding surgery.

In summary, while surgery is often recommended for symptomatic varicocele, especially when testicular atrophy is present, the decision should be made based on a thorough assessment of your symptoms, fertility status, and personal preferences. Regular follow-ups and monitoring are essential to manage the condition effectively.

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