Microsurgical Varicocele Ligation
Varicoceles are common. Up to 15% of men who have fathered children will have varicoceles or dilated veins of the spermatic cord of the testes. These usually occur on the left side of the body and therefore on the left testicle.
The cause of varicoceles is unknown, but very occasionally problems with the kidneys can cause varicocele. Varicoceles are less common (10%) on the right side. Varicoceles can occasionally cause pain in the testicle and this is usually a ‘dragging’ or ‘aching’ pain which occurs at the end of the day or after long periods of standing. Varicoceles are graded according to their size between 1 to 3, with grade 3 being the largest or visible on standing.
There are many treatments advocated for varicoceles, and indications of varicocele treatment are; in young boys where the varicocele may be causing damage to the testis or alternatively in adults who may have pain. Various techniques have been described including open ligation or embolisation, where coils are placed to obliterate the veins. Embolisation is usually performed by a Radiologist.
Varicoceles are also common in men with sub-fertility or fertility problems. However, it remains controversial as to whether or not fixing varicoceles improves pregnancy rates. Current studies are still ongoing. Certainly there is some evidence historically that fixing varicoceles may improve semen parameters, although it is debatable whether or not pregnancy rates are improved.
More recently it has been suggested that varicocele treatment may reduce DNA fragmentation or damage to sperm and hence improve the results from IVF. In evaluating patients with varicocele, the patients should have an ultrasound scan to exclude other testicular causes of pain.