Varicose veins - scrotum

Alternative names
Varicocele

Definition
A varicocele is when the veins along the spermatic cord dilate (widen). The spermatic cord suspends the testicles in the scrotum.

Causes, incidence, and risk factors

A varicocele occurs when the valves within the veins along the spermatic cord don’t work properly. The abnormal valves prevent normal blood flow and cause blood to backup, which dilates and enlarges the veins. (This is essentially the same process as varicose veins, which are common in the legs.)

Varicoceles usually develop slowly and may not have any symptoms. They are more common in men between 15 and 25 years old. Varicoceles are more common on the left side. Varicoceles are often the cause of infertility in men.

The sudden appearance of a varicocele in an older man may be caused by a kidney tumor that has affected the renal vein and altered the blood flow through the spermatic vein.

Symptoms

     
  • Visible, enlarged, twisted veins in the scrotum  
  • Infertility  
  • A painless testicle lump, scrotal swelling, or bulge within the scrotum, more common on the left side

Signs and tests
If you have a varicocele, your physician may feel a non-tender, twisted mass along the spermatic cord. (It feels like a bag of worms.) However, the mass may not be able to be felt or obvious, especially when lying down. The testicle on the side of the varicocele may or may not be smaller compared to the other side.

Treatment

Varicoceles may be managed with a scrotal support. However, if pain continues or if infertility or testicular atrophy results, the varicocele may need to be surgically ligated (tied off).

Varicocelectomy, the surgical correction of a varicocele, is performed on an outpatient basis. The cut is usually made in the lower abdomen, although various techniques can be used. Ice packs should be kept to the area for the first 24 hours after surgery to reduce swelling. You will be advised to wear a scrotal support for some time after surgery.

Possible complications of this procedure include hematoma (blood clot formation), infection, or injury to the scrotal tissue or structures. In addition, injury to the artery that supplies the testicle may occur.

Expectations (prognosis)
A varicocele is usually harmless and often requires no treatment. If surgery is required because of infertility or testicular atrophy, the outlook is usually excellent.

Calling your health care provider

Call for an appointment with your health care provider if you discover a testicle lump or need to treat a diagnosed varicocele.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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