Varicoceles are abnormal enlargements (dilations) of the pampiniform plexus of veins, a group of veins that are connected together and drain the blood from the testicles. This group of veins is believed to be responsible for maintaining testicular temperature in the range necessary for sperm production. They are similar to varicose veins of the leg, and often form during puberty. Left-sided varicoceles are more common than right-sided varicocele, probably because of anatomical differences between the two sides. Ten to fifteen percent of boys have a varicocele.
There are a number of various causes of varicoceles, including an malfunctioning or absent valves within the spermatic veins, which results in may lead to slow or even backflow pooling of blood, ultimately leading to blood stagnation in those veins.
Varicoceles are present in about 15 % of the male population. They do not necessarily lead to infertility, but approximately 40 % of men undergoing evaluation for infertility are found to have a varicocele and decrease sperm motility.
Treatment of varicoceles is indicated in patients with infertility, pain or testicular atrophy. No medical therapies are available for either treatment or prevention.
Besides surgery, there is percutaneous embolization, a procedure performed by radiologists using a special tube that is inserted into a vein in either the groin or neck. Once the enlarged veins of the pampiniform plexus are seen under ultrasound guidance, coils or balloons are released to cause an obstruction (blockage) in the veins, in order to interrupt the blood flow within the pampiniform plexus vessels, thus abolishing the varicocele. This procedure is usually performed under sedation and takes several hours to be finished. Possible complications include varicocele persistence/recurrence, coil migration and complications at the venous access site. This method is not widely used.
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