Summary: Urological referral rarely indicated
Advice: Urological referral is only indicated for troublesome symptoms; treatment of a varicocele for subfertility is rarely indicated
Refer To: Any adult urologist (by generic referral)
Varicoceles occur almost exclusively on the left side and are seen in 10% of otherwise normal males. The development of a right-sided varicocele should always raise suspicion of a retroperitoneal tumour. The sudden onset of a left -sided varicocele in an older man may also indicate the development of a significant left renal tumour.
Aching on standing is the classical symptom of a varicocele. Asymptomatic varicoceles require no treatment and referrals for “reassurance” will no longer be accepted.
20% of infertile men have a varicocele which may be implicated in their infertility. In a subfertile man with a varicocele, NICE guidelines state that treatment of a varicocele is not indicated because of the lack of evidence for any improvement in conception rates, either by natural means or by assisted conception.
- Surgical ligation through the groin
- Surgical ligation above the inguinal canal
- Laparoscopic ligation
- Percutaneous sclerotherapy
- Microsurgical groin ligation
- Transvenous embolisation (the preferred option at Addenbrooke’s)