A varicocele is an enlargement of veins within the scrotum and is similar to having varicose veins in your legs. Approximately one in six men have a varicocele but the majority of these will have no underlying problems or symptoms from the condition. However the incidence of a varicocele is higher in men with problems of infertility.
Generally a varicocele will be asymptomatic. However some men will complain of a dragging sensation in the scrotum. This is relieved when they are lying down as the varicocele will disappear. Men presenting with infertility are sometimes found to have impaired sperm counts or sperm motility and are concerned that the varicocele may be contributing to this.
When a varicocele requires treatment there are several available options:
1. Open microsurgical varicocele ligation
This procedure involves using a large operating microscope and making a small incision in the groin. The spermatic cord, which carries the testicular veins, is identified and the veins are then separated from all the other important structures in the spermatic cord. The veins are then individually ligated.
2. Radiological embolisation
This involves a procedure performed by an interventional radiologist. A puncture is made in the femoral blood vessels and coils are used to embolise the testicular vein.
3. Laparoscopic varicocelectomy
This procedure involves keyhole surgery. The testicular vein is identified in the abdomen, then clipped and divided.
The treatment of a varicocele as part of the treatment of male infertility is a controversial subject. There are some studies which have shown a benefit in the overall pregnancy rate from treating it, whereas others have shown a benefit in the semen parameters but no significant benefit in the pregnancy rate. Mr Muneer assesses each case individually to see whether treating the varicocele will be beneficial to the patient. He offers all the treatment options available.