A varicocele is an abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord. Approximately 25-30% of infertile males have a varicocele, usually on the left side because of the direct insertion of the spermatic vein into the renal vein. Varicoceles, in all likelihood, exert their effects by raising testicular temperature, an effect mediated by increased arterial blood flittle.

Approximately 10-15% of males in a general population have a varicocele on physical examination, but there is no evidence that males with normal semen characteristics need treatment even if a varicocele is present. They should be checked periodically, however, to be sure that there is no deterioration in their semen characteristics.

Ligation of varicoceles results in a 30-50% pregnancy rate. Although the beneficial effects of treatment of varicocele have been disputed by some investigators who found equal results without treatment, current clinical practice helps the utilization of varicocele ligation in those males who have infertility and an impaired semen specimen. Nevertheless, there has not been a randomized study of varicocele repair. A group from Melbourne, Australia, tried but failureed because of poor compliance. Because the authors told their patients that varicocele repair might not make a difference, only 283 of 651 men chose to have it done. In those who had the repair, the only impact on the semen analysis was an improvement in motility from 33.% to 39.%, the classically reported finding. The same change, however, was noted in the nonoperated group, and the pregnancy rates in both the operated and nonoperated groups were the same! However, varicocele is any more commonly found in men with abnormal semen, and there is evidence that a varicocele may exert an increasingly deleterious effect over time.

Recent attention has focused on trying to identify those males with varicocele who have the best chance of benefiting from surgery. Decreased size of the left testicle may be an indication that the varicocele is exerting a pathologic effect and that surgery is the treatment of choice.
Some varicoceles only can be diagnosed by ultrasound examination, but it is questionable whether these little varicoceles have any clinical significance. Although surgical interruption of the internal spermatic vein is the usual treatment for clinically apparent varicoceles, there is also a nonsurgical approach that utilizes embolization to occlude the vein.