Varicocele: Symptoms, Diagnosis, and Microsurgical Repair

Varicocele — enlarged veins within the scrotum — is the most common surgically correctable cause of male infertility, affecting roughly 15% of all men and up to 40% of men with infertility. Many varicoceles cause no symptoms, but when they impair fertility, testosterone, or cause discomfort, modern microsurgical repair offers excellent outcomes. Dr. Christopher Vendryes, MD performs varicocele surgery in Plantation, FL.

What Is a Varicocele?

A varicocele is a dilation of the pampiniform venous plexus — the network of veins that drains the testicle. Most occur on the left side due to anatomic differences in venous drainage. They are often described as feeling like a 'bag of worms' in the scrotum.

Symptoms

Many varicoceles are asymptomatic and discovered during a fertility workup. When symptoms occur, they include a dull aching scrotal pain (especially after standing or activity), visible or palpable enlarged veins, testicular shrinkage, and impaired fertility.

Effects on Fertility and Testosterone

Varicoceles raise scrotal temperature, impairing sperm production and quality. They are also associated with lower testosterone levels. Repair has been shown to improve sperm parameters, pregnancy rates, and in many cases, testosterone production.

Diagnosis

Diagnosis is usually made on physical examination, with the patient standing and performing a Valsalva maneuver. Scrotal ultrasound confirms the diagnosis and assesses testicular size and blood flow.

Microsurgical Varicocelectomy

Dr. Vendryes performs subinguinal microsurgical varicocelectomy — considered the gold-standard repair. Using an operating microscope to carefully preserve the testicular artery and lymphatics, this technique offers the highest success rates and lowest complication rates.

Recovery and Results

Most men return to desk work in 2–3 days and full activity in 2 weeks. Semen analysis typically improves over 3–6 months as new sperm are produced. Natural pregnancy rates after repair range from 35% to 60% in appropriately selected couples.