Disease Description (Causes and Symptoms)
- Definition: A condition in which the veins surrounding the testicle become tortuously dilated, causing backward blood flow (varicocele).
- Causes/Pathophysiology: Mainly due to anatomical characteristics of the left vein (longer course, connection with the renal vein, etc.) and venous valve insufficiency, which increase venous pressure and cause blood stasis, adversely affecting germ cell function through increased testicular temperature, hypoxia, and exposure to toxic substances.
- Main symptoms: Usually asymptomatic. A mass inside the scrotum (palpable as resembling ramen noodles or a bundle of worms), scrotal discomfort/pain, worsening after standing for long periods, testicular atrophy, and an association with male infertility may occur.
- Characteristics: Approximately 90% occur on the left side. They are common after puberty. If they occur on the right side or suddenly on both sides, evaluation for other underlying diseases (e.g., intra-abdominal tumors) is necessary.
Treatment Methods
- Indications: Treatment may be considered in cases of pain, testicular atrophy (a difference in volume between the two sides ≥ 2 mL or cc), sperm abnormalities related to infertility, or progressive lesions. Observation may be appropriate if there are no symptoms and fertility is not affected.
- Surgical treatment
- Microsurgical varicocelectomy (microsurgery): Often recommended because it selectively treats all diseased veins and has the lowest rates of recurrence and complications.
- Open surgery (traditional): Ligation of the veins while preserving the arteries.
- Laparoscopic surgery: Performed through three small incisions; a treatment success rate of approximately 85–95% has been reported.
- Nonsurgical procedure
- Transvenous embolization (embolization): Used selectively in cases of recurrence or when surgical indications are present.
- Drug therapy: Intended to relieve symptoms (e.g., with analgesics). There is no standard drug treatment that corrects varicocele itself.
- Lifestyle management and precautions
- Reduce prolonged standing and activities that increase intra-abdominal pressure (straining forcefully, lifting heavy objects, etc.).
- When pain or swelling occurs, wearing absorbent support (supporter), applying cold or warm compresses, and resting are recommended.
- After surgery, rest and restrictions on sexual activity and lifting heavy objects should follow the instructions provided (follow the doctor's directions).
- Prognosis: After treatment, semen parameters (sperm count and motility) and symptoms improve in most patients, but some may experience recurrence or no improvement. If left untreated, progressive damage to testicular function may occur.
Outpatient Visit Checkpoints (Items to Prepare and Examples of Questions)
- Items to prepare (recommended to bring)
- List of medications/supplements currently being taken (including dosage and administration times)
- Previous test results: semen analysis (if performed), testicular/scrotal ultrasound (Doppler) results, hormone test results, and records of previous surgeries
- Symptom notes: onset, severity and frequency of pain, triggers (when standing/after exercise, etc.), changes in scrotal size, and whether fever or trauma has occurred
- Family history (male infertility, vascular disease, etc.)
- Checkpoints on the day of the outpatient visit
- Which side the symptoms are on and when they are more severe
- Whether you are concerned about infertility (including the length of time you and your partner have been trying to conceive)
- Whether any previous treatment (surgery, embolization, etc.) has been performed
Examples of General Questions to Ask the Doctor
- "Based on my current condition, do you think treatment is necessary? In what situations is observation appropriate?"
- "What treatment do you recommend, and what success rate can be expected (in terms of sperm parameters and symptom improvement)?"
- "What are the complications and recovery period for surgery (or embolization)?"
- "How long does it usually take for sperm parameters to improve after treatment?"
- "What should I be careful about regarding lifestyle (exercise, work, and sexual activity)?"
Examples of Condition-Specific Questions
- "There is a difference of about 2 mL in testicular volume between the two sides (or it has recently become larger/smaller). Do I need treatment right away in this case?"
- "My sperm count and motility were low on the infertility evaluation. To what extent is this varicocele surgery likely to improve fertility (sperm count and motility)?"