Varicocele - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

A varicocele is an abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.
Incidence is 15% in adolescent boys and adult men; 90% occur on the left side; 10% are bilateral.
May impede adolescent testicular growth and affect adult semen parameters and testosterone production.
40% of men evaluated in a male fertility clinic will have a varicocele.
Diagnosis is usually clinical; ultrasound may be helpful where there is doubt about the diagnosis.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. J Urol. 2021 Jan;205(1):36-43.[Abstract][Full Text]
European Association of Urology. Sexual and reproductive health guidelines. Apr 2024 [internet publication]. [Full Text]
Persad E, O'Loughlin CA, Kaur S, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev. 2021 Apr 23;4:CD000479.[Abstract][Full Text]
European Association of Urology. Guidelines on paediatric urology. Apr 2024 [internet publication].[Full Text]

Referenced Articles

1. Nguyen HT. Hernia, hydroceles, testicular torsion, and varicocele. In: Docimo SG, Canning DA, Khoury AE, eds. Clinical pediatric urology. London, UK: Informa Healthcare; 2007.
2. Diamond DA. Adolescent varicocele: emerging understanding. BJU Int. 2003 Oct;92 Suppl 1:48-51.[Abstract]
3. Steeno O, Knops J, Declerck L, et al. Prevention of fertility disorders by detection and treatment of varicocele at school and college age. Andrologia. 1976;8(1):47-53.[Abstract]
4. Kumanov P, Robeva RN, Tomova A. Adolescent varicocele: who is at risk? Pediatrics. 2008 Jan;121(1):e53-7.[Abstract]
5. Sylora JA, Pryor JL. Varicocele. Curr Ther Endocrinol Metab. 1994;5:309-14.[Abstract]
6. Green KF, Turner TT, Howards SS. Varicocele: reversal of the testicular bloodflow and temperature effects by varicocele repair. J Urol. 1984 Jun;131(6):1208-11.[Abstract]
7. World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril. 1992 Jun;57(6):1289-93.[Abstract]
8. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993 Mar;59(3):613-6.[Abstract]
9. Vasavada S, Ross J, Nasrallah P, et al. Prepubertal varicoceles. Urology. 1997 Nov;50(5):774-7.[Abstract]
10. Prabakaran S, Kumanov P, Tomova A, et al. Adolescent varicocele: association with somatometric parameters. Urol Int. 2006;77(2):114-7.[Abstract]
11. Delaney DP, Carr MC, Kolon TF, et al. The physical characteristics of young males with varicocele. BJU Int. 2004 Sep;94(4):624-6.[Abstract]
12. May M, Taymoorian K, Beutner S, et al. Body size and weight as predisposing factors in varicocele. Scand J Urol Nephrol. 2006;40(1):45-8.[Abstract]
13. Xiao-Bin G, Fang-Lei W, Hui X, et al. The association between body mass index and varicocele: a meta-analysis. Int Braz J Urol. 2021 Jan-Feb;47(1):8-19.[Abstract][Full Text]
14. Raman JD, Walmsley K, Goldstein M. Inheritance of varicoceles. Urology. 2005 Jun;65(6):1186-9.[Abstract]
15. Mohammadali Beigi F, Mehrabi S, Javaherforooshzadeh A. Varicocele in brothers of patients with varicocele. Urol J. 2007 Winter;4(1):33-5.[Abstract]
16. Mokhtari G, Pourreza F, Falahatkar S, et al. Comparison of prevalence of varicocele in first-degree relatives of patients with varicocele and male kidney donors. Urology. 2008 Apr;71(4):666-8.[Abstract]
17. Sigmund G, Gall H, Bahren W. Stop-type and shunt-type varicoceles: venographic findings. Radiology. 1987 Apr;163(1):105-10.[Abstract]
18. Bong GW, Koo HP. The adolescent varicocele: to treat or not to treat. Urol Clin North Am. 2004 Aug;31(3):509-15.[Abstract]
19. Wishahi MM. Anatomy of the spermatic venous plexus (pampiniform plexus) in men with and without varicocele: intraoperative venographic study. J Urol. 1992 May;147(5):1285-9.[Abstract]
20. Ates N, Yüksel M, Ylmaz S, et al. Retroperitoneal paraganglioma presenting as right-sided varicocele: case report. Ann Saudi Med. 2016 Mar-Apr;36(2):148-51.[Abstract][Full Text]
21. Cho CL, Esteves SC, Agarwal A. Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation. Asian J Androl. 2016 Mar-Apr;18(2):186-93.[Abstract][Full Text]
22. Paduch DA, Niedzielski J. Semen analysis in young men with varicocele: preliminary study. J Urol. 1996 Aug;156(2 Pt 2):788-90.[Abstract]
23. Macey MR, Owen RC, Ross SS, et al. Best practice in the diagnosis and treatment of varicocele in children and adolescents. Ther Adv Urol. 2018 Jun 22;10(9):273-82.[Abstract][Full Text]
24. Chung JM, Lee SD. Current issues in adolescent varicocele: pediatric urological perspectives. World J Mens Health. 2018 May;36(2):123-31. [Abstract][Full Text]
25. Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. J Urol. 2021 Jan;205(1):36-43.[Abstract][Full Text]
26. Elmer DeWitt M, Greene DJ, Gill B, et al. Isolated right varicocele and incidence of associated cancer. Urology. 2018 Jul;117:82-5.[Abstract][Full Text]
27. Walker AR, Kogan BA. Cost-benefit analysis of scrotal ultrasound in treatment of adolescents with varicocele. J Urol. 2010 May;183(5):2008-11.[Abstract]
28. Freeman S, Bertolotto M, Richenberg J, et al. Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading. Eur Radiol. 2020 Jan;30(1):11-25.[Abstract][Full Text]
29. Tanrikut C, Goldstein M, Rosoff JS, et al. Varicocele as a risk factor for androgen deficiency and effect of repair. BJU Int. 2011 Nov;108(9):1480-4.[Abstract][Full Text]
30. Practice Committee of the American Society for Reproductive Medicine; Society for Male Reproduction and Urology. Report on varicocele and infertility: a committee opinion. Fertil Steril. 2014 Dec;102(6):1556-60.[Abstract][Full Text]
31. European Association of Urology. Sexual and reproductive health guidelines. Apr 2024 [internet publication]. [Full Text]
32. Caliskan Z, Kucukgergin C, Aktan G, et al. Evaluation of sperm DNA fragmentation in male infertility. Andrologia. 2022 Dec;54(11):e14587.[Abstract]
33. Persad E, O'Loughlin CA, Kaur S, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev. 2021 Apr 23;4:CD000479.[Abstract][Full Text]
34. Qiu D, Shi Q, Pan L. Efficacy of varicocelectomy for sperm DNA integrity improvement: a meta-analysis. Andrologia. 2021 Feb;53(1):e13885.[Abstract]
35. Li F, Yamaguchi K, Okada K, et al. Significant improvement of sperm DNA quality after microsurgical repair of varicocele. Syst Biol Reprod Med. 2012 Oct;58(5):274-7.[Abstract][Full Text]
36. Birowo P, Tendi W, Widyahening IS, et al. The benefits of varicocele repair for achieving pregnancy in male infertility: a systematic review and meta-analysis. Heliyon. 2020 Nov 5;6(11):e05439.[Abstract][Full Text]
37. Shah R, Agarwal A, Kavoussi P, et al. Consensus and diversity in the management of varicocele for male infertility: results of a global practice survey and comparison with guidelines and recommendations. World J Mens Health. 2023 Jan;41(1):164-97.[Abstract][Full Text]
38. Birowo P, Rahendra Wijaya J, Atmoko W, et al. The effects of varicocelectomy on the DNA fragmentation index and other sperm parameters: a meta-analysis. Basic Clin Androl. 2020 Sep 10:30:15.[Abstract][Full Text]
39. Punjani N, Wald G, Gaffney CD, et al. Predictors of varicocele-associated pain and its impact on semen parameters following microsurgical repair. Andrologia. 2021 Sep;53(8):e14121.[Abstract]
40. Diamond DA, Paltiel HJ, DiCanzio J, et al. Comparative assessment of pediatric testicular volume: orchidometer versus ultrasound. J Urol. 2000 Sep;164(3 Pt 2):1111-4.[Abstract]
41. Meacham RB, Townsend RR, Rademacher D, et al. The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography. J Urol. 1994 Jun;151(6):1535-8.[Abstract]
42. Kursh ED. What is the incidence of varicocele in a fertile population? Fertil Steril. 1987 Sep;48(3):510-1.[Abstract]
43. Bogaert G, Orye C, De Win G. Pubertal screening and treatment for varicocele do not improve chance of paternity as adult. J Urol. 2013 Jun;189(6):2298-303.[Abstract]
44. Bogaert GA. Adolescent varicocele: limited indications for treatment during puberty and adolescence. Transl Androl Urol. 2014 Dec;3(4):398-401.[Abstract][Full Text]
45. European Association of Urology. Guidelines on paediatric urology. Apr 2024 [internet publication].[Full Text]
46. Yuan R, Zhuo H, Cao D, et al. Efficacy and safety of varicocelectomies: a meta-analysis. Syst Biol Reprod Med. 2017 Apr;63(2):120-9.[Abstract][Full Text]
47. Al-Kandari AM, Shabaan H, Ibrahim HM, et al. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007 Mar;69(3):417-20.[Abstract][Full Text]
48. Al-Said S, Al-Naimi A, Al-Ansari A, Y, et al. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008 Jul;180(1):266-70.[Abstract]
49. Baazeem A, Belzile E, Ciampi A, et al. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol. 2011 Oct;60(4):796-808.[Abstract]
50. Ding H, Tian J, Du W, et al. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int. 2012 Nov;110(10):1536-42.[Abstract]
51. Diamond DA, Zurakowski D, Atala A, et al. Is adolescent varicocele a progressive disease process? J Urol. 2004 Oct;172(4 pt 2):1746-8; discussion 1748.[Abstract]
52. Thomas JC, Elder JS. Testicular growth arrest and adolescent varicocele: does varicocele size make a difference? J Urol. 2002 Oct;168(4 Pt 2):1689-91.[Abstract]
53. Laven JS, Haans LC, Mali WP, et al. Effects of varicocele treatment in adolescents: a randomized study. Fertil Steril. 1992 Oct;58(4):756-62.[Abstract]
54. Li F, Chiba K, Yamaguchi K, et al. Effect of varicocelectomy on testicular volume in children and adolescents: a meta-analysis. Urology. 2012 Jun;79(6):1340-5.[Abstract]
55. Owen RC, McCormick BJ, Figler BD, et al. A review of varicocele repair for pain. Transl Androl Urol. 2017 May;6(suppl 1):S20-9.[Abstract][Full Text]
56. Esteves SC, Roque M, Agarwal A. Outcome of assisted reproductive technology in men with treated and untreated varicocele: systematic review and meta-analysis. Asian J Androl. 2016 Mar-Apr;18(2):254-8.[Abstract][Full Text]
57. Kirby EW, Wiener LE, Rajanahally S, et al. Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis. Fertil Steril. 2016 Nov;106(6):1338-43.[Abstract]
58. Practice Committee of the American Society for Reproductive Medicine. Management of nonobstructive azoospermia: a committee opinion. Fertil Steril. 2018 Dec;110(7):1239-45.[Abstract][Full Text]
59. Asafu-Adjei D, Judge C, Deibert CM, et al. Systematic review of the impact of varicocele grade on response to surgical management. J Urol. 2020 Jan;203(1):48-56.[Abstract][Full Text]
60. Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II. J Urol. 2021 Jan;205(1):44-51.[Abstract][Full Text]
61. Chen X, Yang D, Lin G, et al. Efficacy of varicocelectomy in the treatment of hypogonadism in subfertile males with clinical varicocele: a meta-analysis. Andrologia. 2017 Dec;49(10).[Abstract]
62. Schauer I, Madersbacher S, Jost R, et al. The impact of varicocelectomy on sperm parameters: a meta-analysis. J Urol. 2012 May;187(5):1540-7.[Abstract]
63. Esteves SC, Miyaoka R, Roque M, et al. Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl. 2016 Mar-Apr;18(2):246-53.[Abstract][Full Text]
64. Sajadi H, Hosseini J, Farrahi F, et al. Varicocelectomy may improve results for sperm retrieval and pregnancy rate in non-obstructive azoospermic men. Int J Fertil Steril. 2019 Jan;12(4):303-5.[Abstract][Full Text]
65. Fallara G, Capogrosso P, Pozzi E, et al. The effect of varicocele treatment on fertility in adults: a systematic review and meta-analysis of published prospective trials. Eur Urol Focus. 2023 Jan;9(1):154-61.[Abstract]
66. Li F, Yue H, Yamaguchi K, et al. Effect of surgical repair on testosterone production in infertile men with varicocele: a meta-analysis. Int J Urol. 2012 Feb;19(2):149-54.[Abstract]
67. Wang YJ, Zhang RQ, Lin YJ, et al. Relationship between varicocele and sperm DNA damage and the effect of varicocele repair: a meta-analysis. Reprod Biomed Online. 2012 Sep;25(3):307-14.[Abstract]
68. Esposito C, Valla JS, Najmaldin A, et al. Incidence and management of hydrocele following varicocele surgery in children. J Urol. 2004 Mar;171(3):1271-3.[Abstract]
69. Misseri R, Gershbein AB, Horowitz M, et al. The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long-term follow-up. BJU Int. 2001 Apr;87(6):494-8.[Abstract]