Advice: A symptomatic varicocoele can be referred for consideration of treatment. A mild ache after prolonged standing is common, and if not troublesome doesn’t warrant treatment. Although 20% of subfertile men have evidence of varicocoele, there is no evidence that treatment has an impact on pregnancy rate.
Sudden onset warrants urgent investigation (USS renal tract, if normal consider CT Abdomen), as does a right-sided varicocoele.
Refer To: Urologist
Left sided varicocoele is a common problem, and often subclinical (discovered in ultrasound scan). Most are asymptomatic or mildly symptomatic, and do not need further investigation. Exceptions to this are:
- Symptomatic varicocoele, causing significant discomfort
- Right sided varicocoele
- Sudden onset of varicocoele on either side
Interestingly, 20% of subfertile men have evidence of varicocoele, but there is insufficient evidence that treatment has an impact on subsequent fertility rate, so this is generally not performed.
Treatment options include:
- Laparoscopic ligation
- Micro-surgical ligation
- Venous embolization
If referred, these will be discussed with your patient if treatment is needed.