A scrotal varicocele is an enlargement of the veins (pampiniform plexus) of the spermatic cord, a bundle of tissues that is found within the scrotum. These veins drain blood from the testes, epididymis, and vas deferens. A varicocele is much like a varicose vein of the leg. Scrotal varicoceles are among the most commonly identifiable and surgically correctable factors that contribute to poor testicular function and decreased sperm quality. They can also cause significant testicular pain and loss of testicular size. About 20 percent of the general male population has a varicocele, but the condition is present in about 40 percent of infertile men.

Varicoceles can be large, moderate, or small. However, the size of the varicocele is not related to the degree of changes seen in the sperm quality. Up to 40 percent of infertile men have bilateral varicoceles (on both testicles). A varicocele on one testicle can often have an effect on the other testicle.

Evaluation
A scrotal varicocele is diagnosed by a physical examination performed by urologist David Shin, M.D. The patient is examined in a standing position while he takes a deep breath and bears down. An imaging study called a high-resolution color-flow Doppler ultrasonogram may also be used to detect small varicoceles.

Treatment 
A varicocele can be corrected with surgery. Abnormal veins are permanently tied off to prevent continued abnormal blood flow. After a varicocele repair, there is generally an improvement in semen quality in close to 70 percent of patients, and the pregnancy rate is 40 percent. The average pregnancy occurs six to nine months following surgery.

At Hackensack University Medical Center, Dr. Shin uses the microsurgical technique to repair varicoceles:

• A transinguinal or subinguinal approach is performed using an operating microscope to identify and tie off the abnormally enlarged veins that cause the varicocele.

Microsurgical varicocelectomies are outpatient procedures, and patients go home on the same day of surgery.