Varicocele is the most common reversible cause of male infertility. With over 30 years of experience and 6000+ successful microsurgery operations, we offer you the best treatment results.
Varicocele is the abnormal enlargement of the network of veins called the pampiniform plexus that drains the testicles. This condition occurs as a result of the relaxation of the vessels and the insufficiency of the valves that prevent the backflow of blood, much like the varicose veins seen in the legs. Varicocele is seen in approximately 15-20% of men and in 40% of infertile men.
Varicocele typically occurs in the left testicle (in 85-90% of cases). This is because the left testicular vein drains into the left renal vein at a right angle and follows an anatomically longer path. On the right side, the testicular vein opens directly into the inferior vena cava, and this condition causes varicocele less frequently. Bilateral (both sides) varicocele is seen in approximately 30-40% of cases.
Varicocele is the most common reversible cause of infertility in men. With early diagnosis and appropriate treatment, significant improvement in sperm quality can be achieved.
Under normal conditions, blood in the testicles is pumped upwards back to the heart through veins. One-way valves inside these vessels prevent blood from flowing back under the influence of gravity. Varicocele occurs as a result of these valves failing or losing their function completely.
As a result of valve insufficiency, blood flows backwards and accumulates in the vessels around the testicle. This accumulation causes the vessels to enlarge and twist over time. Enlarged and twisted vessels form the characteristic appearance described as a "bag of worms" in the scrotum (scrotal sac).
Varicocele usually begins during puberty and its prevalence increases with age. Rapid growth and hormonal changes during puberty increase testicular blood flow, and this can reveal existing valve insufficiencies.
Varicocele negatively affects testicular functions through many mechanisms:
The symptoms of varicocele can vary greatly from person to person. A significant portion of patients (50-60%) do not experience any symptoms, and varicocele is detected by chance, for example, during an infertility investigation or routine examination.
Varicocele pain shows characteristic features:
Sudden onset of severe testicular pain may be a sign of an emergency such as testicular torsion. In such cases, medical help should be sought immediately.
Varicocele is usually associated with the following reproductive problems:
Varicocele is primarily diagnosed by physical examination. The examination should be performed in the standing position. Imaging methods are used to confirm and grade the diagnosis.
Physical examination is the cornerstone of varicocele diagnosis. The examination should be performed in both the lying and standing positions. Enlarged veins become more prominent when the patient is standing and performing the Valsalva maneuver (straining).
Varicocele is classified as follows based on physical examination findings:
| Stage (Grade) | Physical Examination Finding | Clinical Importance | Treatment Approach |
|---|---|---|---|
| Subclinical | Not palpable on physical examination, detected only by Doppler USG | Clinical importance is controversial | Usually no treatment required, follow-up |
| Grade 1 | Palpable only during the Valsalva maneuver | Mild varicocele, may require monitoring | Based on the presence of symptoms and infertility |
| Grade 2 | Easily palpable while standing, without Valsalva | Moderate, may affect sperm quality | Treatment is usually recommended |
| Grade 3 | Visually observable, as a distinct mass | Advanced stage, risk of testicular atrophy | Surgical treatment is definitely recommended |
Important: The effect on sperm quality is not always parallel to the grade of varicocele. Even Grade 1 varicocele can cause significant sperm parameter abnormalities, while some men with Grade 3 varicocele may have normal sperm quality. Therefore, the treatment decision should be made by evaluating physical examination findings together with semen analysis, testicular dimensions, and the patient's symptoms.
Color Doppler USG is the gold standard imaging method in the diagnosis of varicocele. This examination:
Semen analysis is of critical importance in the evaluation of varicocele. It is evaluated according to World Health Organization (WHO) criteria:
FSH, LH, and testosterone levels may be measured in selected cases. Hormonal evaluation is important especially in cases of severe oligospermia or azoospermia.
There are different surgical and interventional methods in the treatment of varicocele. The following table presents a comparative analysis of these methods:
| Treatment Method | Success Rate | Recurrence Rate | Complication | Advantages |
|---|---|---|---|---|
| Microsurgery (Subinguinal) | %99+ | <%1 | <%1 | Lowest recurrence and complications, protects the artery |
| Laparoscopic | %90-95 | %3-5 | %3-5 | Single incision in bilateral cases |
| Open Inguinal Surgery | %85-90 | %5-10 | %5-10 | Does not require general anesthesia |
| Radiological Embolization | %85-90 | %10-15 | %5 | Non-invasive, performed as outpatient |
Microsurgical varicocelectomy is the gold standard treatment method performed using an operation microscope. Thanks to this technique, testicular artery and lymphatic vessels are preserved, preventing hydrocele and testicular nutrition problems. In addition, all internal and external spermatic veins are safely tied, minimizing the risk of recurrence.
The success of varicocele surgery is evaluated by the improvement in sperm parameters and pregnancy rates. Expected results based on clinical studies:
An average increase of 60-80% is observed in sperm concentration after surgery. Improvement usually begins within 3-6 months.
A 40-60% increase in progressive motility is expected. Increased motility significantly raises the chance of natural pregnancy.
A 20-40% improvement in the ratio of sperm with normal morphology. A significant reduction in DNA damage is also seen.
The natural pregnancy rate within 12 months is between 30-50%. This rate increases even more with assisted reproductive techniques.
These rates can vary based on the patient's age, the spouse's age, the grade of varicocele, pre-surgery sperm values, and other accompanying factors. Personalized evaluation and expectation management are important for each patient.
We have compiled the most frequently asked questions for you.
Yes, mild to moderate pain and swelling after surgery are completely normal. This discomfort usually subsides within 1-2 weeks and can be controlled with simple painkillers.
Ice application and the use of supportive underwear help reduce pain. However, in case of severe, increasing pain or pain accompanied by fever, you should consult your doctor.
Microsurgical varicocelectomy is a proven effective treatment for improving sperm quality in infertile men. Improvement in sperm parameters (count, motility, morphology) is seen in approximately 60-80% of patients after surgery.
Natural pregnancy rates are between 30-50% within 12 months. However, results depend on factors such as the patient's age, the spouse's age, pre-surgery sperm values, and other accompanying factors.
Microsurgical varicocelectomy takes an average of 45-60 minutes. While this time may be shorter in unilateral cases, it can extend up to 90 minutes in bilateral (both sides) cases.
The surgery is performed under local or spinal anesthesia and the patient is usually discharged on the same day. Being performed as day surgery allows the patient to rest in their own home.
No, varicocele does not go away on its own. On the contrary, if not treated, it can progress over time and negative effects on the testicle can increase. Enlarged vessels and valve insufficiency are permanent structural changes.
Even in early stages, varicocele can negatively affect sperm quality. Therefore, early treatment is recommended, especially in patients who want to have children or are symptomatic.
The return to work time depends on the level of physical activity required by your profession:
Heavy lifting (over 5 kg) and intense exercise should be avoided for 4-6 weeks. It is usually recommended to wait 2 weeks for sexual activity.
Urology and Andrology Specialist
One of the leading names in the treatment of varicocele and male infertility in Turkey, Prof. Dr. Teoman Cem Kadıoğlu offers the best results to his patients with over 30 years of clinical experience and more than 6000 successful microsurgery operations.
Prof. Dr. Kadıoğlu, who has many scientific articles published nationally and internationally, is a member of the American Urological Association (AUA) and the European Association of Urology (EAU).
The information on this page is based on current guidelines and studies published in peer-reviewed journals:
You can visit the relevant page for more than 50 scientific articles and PubMed-referenced studies of Prof. Dr. Kadıoğlu published in national and international peer-reviewed journals:
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