Most varicoceles are asymptomatic; however, they may cause pain that varies from mild discomfort to a severe sharp pain. It is a dull, congestive, tooth-ache like pain and is not associated with urination problems or erectile dysfunction. Pain increases with standing and physical exertion over long periods of time and worsens over the course of a day. The pain is usually relieved by lying down.

When it enlarges, the varicocele can cause a clumpy “bag of worms” feel in the scrotum. Typically, painful varicoceles are prominent in size. A decreased sperm count, decreased motility of sperm and increase in the temperature due to varicoceles usually result in infertility in men. Testicular atrophy may also be seen in young boys at puberty.

• Leg Edema

  Affected patients usually present with unilateral leg edema. The condition is most often seen in women, in whom it may also be a cause of vulvar varicosities. [ncbi.nlm.nih.gov]

• Vein Disorder

  A varicose vein disorder can be a cause of male infertility but is fortunately, also the most surgically correctable. [malefertility.md]

• Impulsivity

  Cough impulse may be present. Cough impulse will be present as the lesion becomes prominent with increased intra-abdominal pressure during coughing. Cough impulse may be present. [medicaljoyworks.com]

   Cough impulse present Long standing cases- affected side testis is reduced in size and softer. Fertility problems. 9. [slideshare.net]

  There may be a cough impulse. Most are in the left testicle (80-90%), some bilateral (as many as 35-40% radiologically) and very few just on the right side. [ 8 ] Size. They vary in size and may be classified as: Large. [patient.info]

  The physician may feel an impulse when the blood pushes backwards (because of the increased pressure inside the abdomen) into the scrotum. [mazemenshealth.com]

• Swelling of the Scrotum

  Alerts and Notices Synopsis   A varicocele is a usually painless swelling of the scrotum involving dilated spermatic veins (pampiniform plexus) that form a soft scrotal mass, most often on the left side. [visualdx.com]

  The swelling of the veins can also be palpable—one can feel the swelling and twisting of the veins in the scrotum. At times, varicoceles can cause pain within the scrotum or heaviness in the testicles. [docdoc.com.sg]

  Symptoms of a Varicocele Most men with a varicocele won’t experience any symptoms, but potential symptoms of a varicocele include: A lump in one of your testicles (typically on the left side) Pain and/or swelling in your scrotum Infertility Varicoceles [ccrmivf.com]

  Varicoceles are a widening and swelling of veins in the scrotum that are similar to varicose veins in the legs or hemorrhoids. [sharecare.com]

• Scrotal Mass

  ‘Other benign conditions resulting in a scrotal mass, such as testicular torsion, spermatocele, varicocele, or tuberculosis, must be ruled out.’ ‘Scrotal ultrasonography is helpful in confirming a varicocele or testicular tumour.’ [en.oxforddictionaries.com]

  Painless scrotal mass. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/genitourinary-disorders/symptoms-of-genitourinary-disorders/painless-scrotal-mass. Updated March 2017. Accessed March 8, 2018. [winchesterhospital.org]

  Alerts and Notices Synopsis   A varicocele is a usually painless swelling of the scrotum involving dilated spermatic veins (pampiniform plexus) that form a soft scrotal mass, most often on the left side. [visualdx.com]

  (A scrotal mass can turn out to be a varicocele, or benign dilated veins.) In the conventional operation to correct a varicocele, the surgeon ties off the engorged vein so more blood can't accumulate. [diki.pl]

• Testicular Swelling

  We describe the sonographic and colour Doppler appearances of this poorly described entity in a middle-aged man referred for evaluation of a painful left testicular swelling. [ncbi.nlm.nih.gov]

• Microscopic Hematuria

  The diagnosis was eventually made when he returned with microscopic hematuria, elevated serum creatinine level, and nonfunction of the left kidney; computed tomography scan demonstrated a 6-cm abdominal aortic aneurysm, a retroaortic left renal vein, [ncbi.nlm.nih.gov]

The gold standard way to diagnose varicocele is by physical examination. About 95 percent of varicoceles are found on the left side of the scrotum. The general physical examination of a patient in standing position reveal a tender, non twisted mass above the testicle.

If large enough, it can be felt as a bag of worms. If a varicocele is small, it can be felt by asking the patient to take a deep breath and hold it (Valsalva maneuver). The testicles may be shrunken in size.

During palpation, a varicocele must be differentiated from the lipoma of the cord. Unlike a varicocele, a lipoma will not go away when the patient lies down.

A noninvasive imaging exam called color flow ultrasound or a venogram can often be used to detect a varicocele, if not diagnosed through the physical examination.

• Hyperviscosity

  In addition, patients with DPVP were significantly more likely to have seminal fluid hyperviscosity, and their viscosity quantitative measurement remained significantly higher after varicocele repair, compared with patients without DPVP. [12] Varicoceles [emedicine.com]

• Sperm Count Decreased

  A decreased sperm count, decreased motility of sperm and increase in the temperature due to varicoceles usually result in infertility in men. Testicular atrophy may also be seen in young boys at puberty. [symptoma.com]

  Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm are related to varicoceles. [radiology.ucsf.edu]

  Fertility problems including decreased sperm count, decreased motility and an increase in the number of deformed sperm. Atrophy (shrinking) of the affected testicle. How is varicocele diagnosed? The gold standard is a physical examination. [drshrid.com]

  Other signs of varicoceles can be a decreased sperm count; decreased motility, or movement, of sperm; and an increase in the number of deformed sperm. [indianinterventionalradiology.com]

  The detrimental effect of varicocele on spermatogenesis in the subfertile male is manifested by low sperm count, decreased sperm motility and low percentage of normal sperm morphology together or in different combinations. [stonybrookmedicine.edu]

Varicocele treatment may not be necessary until it causes pain, testicular atrophy or infertility in men. There are both surgical and non-surgical options available to treat a varicocele. The purpose of treatment is to seal off affected veins to redirect the blood flow into normal veins.

• Varicocele embolization: A catheter directed varicocele embolization is a nonsurgical treatment that is highly effective to treat symptomatic varicoceles [5] [6]. A thin catheter is passed directly to the testicular vein at the groin under local anesthesia. The abnormal veins can be blocked by using coils or sclerosants under direct visualization of the veins. By embolizing the vein, blood flow is redirected to normal veins through alternate pathways.
• Varicocelectomy: The most common surgical procedure to treat varicocele is surgical ligation which is known as varicocelectomy [7]. The most common approaches are inguinal, retroperitoneal and subinguinal [8]. A specially designed surgical instrument can be used to cut the veins by making two small incisions in the groin under general anesthesia. Patients of open surgical ligation can expect a two to three week recovery period.
• Medical treatment with L-carnitine also has a beneficial effect [9] [10].

Varicoceles may be harmless but in some cases they can cause infertility and pain. About 2% to 5% of patients develop a condition called hydrocele. There are studies showing improvement in sperm quality in 57% of the cases after varicocelectomy. Recurrences are common and occur in 5% to 20% of the cases.

Varicoceles usually develop in men older than 40 years of age due to blockage of large veins higher in abdomen. The major risk factors associated with varicocele include obesity and tumor masses such as kidney tumor. Both of these conditions cause pressure on the veins which can block blood flow to the veins.

The majority of varicoceles develop in teenagers and young men and are not due to a serious condition. There may also be a genetic cause of varicocele as the condition occurs usually in individuals of the same family.

Varicoceles are a relatively common condition affecting approximately 10 percent of men. These are more common in young men, usually during the second and third decade of life.

About 40 percent cases of infertility in men occur due to varicoceles. Nine out of ten varicoceles develop in the left testicles, although it can be bilateral at the same time. The prevalence of varicocele may be as high as 80%.

A varicocele forms when the valves inside the veins in the spermatic cord do not function properly. In healthy veins within the scrotum, one-way valves allow blood to flow from testicles and scrotum back to the heart. In varicoceles, the poor functioning valves and increased resistance to blood flow result in increased venous pressure. This can cause dilation and tortuosity of the pampiniform plexus, which is a network of veins that drain the testicle.

One of the main functions of the plexus is to lower the temperature of the testicles; varicoceles cause this function to be lost and lead to a higher temperature of the testes causing testicular atrophy. Due to reduction in the supply of oxygenated blood and nutrient material to the sperm production sites, the quality and the quantity of the sperms is affected, causing infertility in men [2].

A secondary varicocele is due to compression of the venous drainage of the testicle [3] [4]. The most common cause is renal cell carcinoma. One non-malignant cause of a secondary varicocele is Nut-cracker syndrome, a condition in which superior mesenteric artery compresses the left renal vein causing increased pressure to be transmitted into the left pampiniform plexus.

A varicocele cannot be prevented from developing; however, the preventive measures that can be helpful include self-monitoring, regular checking of testicles every month knowing what they look and feel like, and look for any change in the shape and size of scrotum.

As high temperatures can trigger a wide veins around the testicles, so being in a room with high temperature continuously must be avoided. Moreover, it is recommended to wear special pants as protector and avoid too much wear jeans or tights. The activities such as unskilled labor, heavy weight lifting must be avoided to prevent varicoceles.

Varicocele is a mass of enlarged and dilated veins within the scrotum [1]. It is a varicose vein of the testicle and scrotum that may cause pain and lead to testicular shrinkage.

The condition is usually characterized by visible veins and feeling of heaviness in the testicle. Varicoceles are a common cause of infertility in men due to poor quality of the sperms that are produced in this disorder.

Varicoceles are observed in 15% of the male population and are generally acquired during puberty. If a varicocele causes symptoms, it can be repaired surgically.

Varicocele is the swelling of veins inside the scrotum. The condition is common in young boys at puberty and men older than 40 years of age. The patients usually present with visible enlarged veins, pain within the scrotum and feeling of heaviness in the testicle. It can be treated by surgical procedure.

1. Agger P. [Scrotal varicocele. A review]. Ugeskrift for laeger. Feb 14 1972;134(7):317-320.
2. Lu YQ, Chen B. [Progress in researches on the mechanism of varicocele-induced male infertility]. Zhonghua nan ke xue = National journal of andrology. May 2008;14(5):454-458.
3. Masuda F, Kudo K, Sasaki T, Onodera S, Machida T. [Varicocele as a symptom in renal cell carcinoma (author's transl)]. Nihon Hinyokika Gakkai zasshi. The japanese journal of urology. Dec 1975;66(12):876-880.
4. Espinosa Bravo R, Lemourt Oliva M, Perez Monzon AF, et al. [Renal cell carcinoma and simultaneous left varicocele]. Archivos espanoles de urologia. Jun 2003;56(5):533-535.
5. Gonzalez R, Narayan P, Castaneda-Zuniga WR, Amplatz K. Transvenous embolization of the internal spermatic veins for the treatment of varicocele scroti. The Urologic clinics of North America. Feb 1982;9(1):177-184.
6. Gonzalez R, Narayan P, Formanek A, Amplatz K. Transvenous embolization of internal spermatic veins: nonoperative approach to treatment of varicocele. Urology. Mar 1981;17(3):246-248.
7. Raheem OA. Surgical management of adolescent varicocele: Systematic review of the world literature. Urology annals. Jul 2013;5(3):133-139.
8. Zini A. Varicocelectomy: microsurgical subinguinal technique is the treatment of choice. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. Sep 2007;1(3):273-276.
9. Cavallini G, Ferraretti AP, Gianaroli L, Biagiotti G, Vitali G. Cinnoxicam and L-carnitine/acetyl-L-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermia. Journal of andrology. Sep-Oct 2004;25(5):761-770; discussion 771-762.
10. Akdemir S, Gurocak S, Konac E, et al. Different surgical techniques and L-carnitine supplementation in an experimental varicocele model. Andrologia. Oct 10 2013.