A varicocoele is a common benign cause of a swelling or lump in the scrotum; it is an abnormal enlargement of the veins around the testicle. These veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the groin as part of the spermatic cord on their way to the testis.
If you have a swelling or lump in the scrotum, this should be investigated to ensure there is no suspicion of a tumour in the testicle. However, much more common causes of scrotal lumps are usually benign such as cysts. The cause of any mass can usually be confirmed simply and quickly with an ultrasound scan.
Varicoceles are one such cause of benign scrotal lumps and occur in around 15% to 20% of all men. The incidence of varicocele increase with age. If a varicocoele is present, this can also be confirmed with scrotal ultrasound which will show dilation of the vessels.
Varicocele might be noticed as soft lumps (often described as ‘a bag of worms’), usually above the testicle and mostly on the left side. Right-sided and bilateral varicocele can also occur. Men with varicocele can feel symptoms of pain or heaviness (a dragging sensation) in their scrotum. This dull aching discomfort may be worse on standing for long periods or on straining. Varicocoele is sometimes discovered when investigating the cause of male infertility.
The likely cause for varicocoeles relates to the venous anatomy. Firstly, the testicular vein on the left side connects to the larger outflowing kidney vein at a right angle. This tends to fail meaning the draining blood flow is poor and venous blood backs up, distending the veins around the testicle. Also there are no valves in this vein meaning there can be insufficiency, again exacerbating the problem. In rare cases, pressure from certain arteries at the top of the abdomen can compress the veins, again preventing good flow.
One concern around varicocoele is its effect on male fertility. The precise relationship between varicocele and infertility is unclear but some men with varicocoele have sperm with abnormal shapes or poor function. It is thought that poor blood flow in the varicocoele may give a warming effect in the testicle leading to less sperm production which is usually optimal at around 35℃ rather than core body temperature of 37℃.
Tobacco smoking and certain gene mutations both put men at risk for infertility; these factors may also exacerbate the risk that varicocele will affect fertility.
Treatment is usually undertaken for two main reasons; persistent symptoms troubling the patient or to assist in treatment of infertility.
Embolisation
this is a percutaneous technique done by an Interventional Radiologist as a day case under local anaesthetic. It is minimally invasive and the recovery period is quick. Patients can expect to resume their full range of normal activities the following day.
Surgery
the two most common surgical approaches are via the abdomen using laparoscopic surgery or in the scrotum. In both cases, usually the surgeon will tie off the relevant veins to deal with the varicocoele.
If you are concerned about a scrotal lump, we are happy to see you, perform ultrasound to make a diagnosis and advise as to the best way forwards. If you already have a diagnosis of varicocoele, we will see you as a referral from your GP or Consultant to assess whether embolization is right for you.