Varicocele is a common condition that can cause various health problems in men, including:

• Insufficient growth and development of the testicle on the affected side.
• Pain and discomfort in the testicles.
• Difficulty conceiving (subfertility).
• Low testosterone levels (hypogonadism).

Classification

There are different degrees of varicocele, which help to understand the severity of the problem:

• Subclinical: Not felt or seen, but can be detected with specific tests (color-Doppler ultrasound).
• Grade 1: Felt only when the patient performs a specific effort (Valsalva maneuver).
• Grade 2: Felt at rest but not visible.
• Grade 3: Visible and felt even at rest.

Diagnostic Evaluation

To diagnose varicocele, the doctor performs a clinical examination which is confirmed with a specific ultrasound (color-Doppler). In specialized centers where treatments like sclerotherapy or embolization are performed, the diagnosis is also confirmed with a radiographic study.

General Considerations

Varicocele and Infertility

Varicocele is present in 11.7% of adult men and 25.4% of those with sperm problems. Although it is not clear how varicocele affects fertility, recent studies show that sperm parameters improve after surgical correction. Additionally, surgery can reduce DNA damage in sperm cells.

Varicocele Correction

The correction of varicocele is primarily indicated in cases of infertility related to issues with sperm quality or quantity, in the presence of chronic pain or persistent discomfort unrelieved by conservative treatments (although this occurs in a very small percentage of cases), in situations of reduced development or loss of testicular volume, especially in young individuals, or when there is a progressive worsening of the varicocele that could compromise reproductive health over time. If the varicocele is of a high grade, correction may also be considered for aesthetic reasons or at the patient’s request (although the dilation of veins visible externally does not disappear after the procedure).

Preventive Varicocele Correction

In adolescents, there is a significant risk of overtreatment because most will not have issues with fatherhood later in life. Preventive treatment is recommended only if there is compromised testicular growth or if there are alterations in sperm parameters, documented by serial clinical examinations.

Treatment

There are various treatments available for varicocele. Current research shows that microsurgical correction is the most effective. This technique results in fewer complications and lower recurrence rates compared to other options but requires specific microsurgical training. While other techniques are still valid, they have a higher chance of recurrence or may result in a hydrocele (fluid accumulation) post-operation.

In Conclusion: Having a varicocele does not necessarily mean having a problem that needs to be solved, but it does require careful study of the patient and offering the best treatment and appropriate medical support.