Scrotal Varicocele Treatment in New York City

by Dr. Alex Shteynshlyuger


If you have any questions, schedule a consultation, contact us or call 212-204-6300.


Treatment of Scrotal Varicocele in Men

What is a Varicocele?

The term varicocele refers to an enlargement of the veins in the scrotum (the ball-sac or loose pouch of skin that contains the testicles). A scrotal varicocele is similar to varicose veins in the leg. It occurs due to defective valves in the veins leading to the backing up of blood and dilatation of the veins.

Varicocele is one of the most common treatable causes of male infertility because it leads to low sperm count and poor sperm quality. Men with varicocele have been found to have significantly lower levels of testosterone. Treatment of this condition with a procedure called varicocelectomy results in considerable improvement in symptoms and semen parameters.

Why Choose New York Urology Specialists for Treatment of Varicoceles?

Dr. Alex Shteynshlyuger is one of the most experienced surgeons specializing in the treatment of scrotal varicoceles in New York City. We offer advanced diagnostic tools, including color Doppler ultrasound. At our practice, we use the most effective treatment available for this condition, microscopic varicocelectomy.

Our board-certified surgeons have extensive experience in correcting varicoceles. With a low complication rate and low recurrence rate, most patients experience quick recovery and return to usual activities within a few days of the procedure.

We offer affordable treatment plans for patients with high deductibles or patients without health insurance. We also treat varicoceles in patients visiting New York City from overseas or elsewhere in the United States.

Why Do Men Get Varicoceles?

There are no dietary or behavioral activities that predispose a man to varicocele. It appears that some men have a predisposition to develop enlarged veins in the scrotum, which typically occurs either during adolescence or young adulthood. Strenuous activities which place pressure on the abdominal area may be a risk factor for scrotal varicocele, but most men who engage in weightlifting and other strenuous activities do not develop clinical varicoceles.

What Are the Symptoms of a Varicocele?

Oftentimes, men with varicoceles have no symptoms at all and remain unaware that they have this condition. If symptoms are present, they usually consist of a dull ache or heavy feeling in the scrotum, which is typically worse after physical exertion or in hot weather and is relieved by lying down on the back. Varicoceles are more common on the left side. Dilated veins may be visible or palpable on the scrotum. The twisted and swollen veins in the testicular area feel similar to a bag of worms.

What Can Varicoceles Be Mistaken For? How is Varicocele Diagnosed?

Varicoceles can sometimes be mistaken for inguinal hernia, hydrocele, or testicular mass.  Experienced urologists can usually make a diagnosis on physical examination. A color duplex ultrasound can confirm the diagnosis.

Should I Worry If I Have a Varicocele?

Varicocele is a common condition. It is more frequently seen in younger males between 15 and 25 years old [2]. Depending on how one defines the diagnosis, as many as 40 percent of men may be found to have a scrotal varicocele. On ultrasound examination, many men have a scrotal varicocele; however, only some of them will have a palpable or visible enlargement of the veins.  Traditionally only varicoceles that can be palpated on the physical exam are treated; sometimes varicoceles that are not easily palpable but visible on ultrasound may require treatment.

Most varicoceles do not cause symptoms. In adolescent boys, this condition can impair testicular growth, and if that happens, varicocelectomy should be performed, which usually leads to catch-up growth of the smaller testicle.

In adult males, varicoceles can lead to infertility and impaired semen parameters. Some men with varicoceles experience low testosterone levels. Varicocelectomy can improve testosterone levels by an average of 150 points in most men with a clinically palpable varicocele. Some men with palpable varicocele experience scrotal pain, ache, and discomfort that typically lasts for more than 3 months and is worse with exertion.

Treatment Options for Scrotal Varicoceles in Men: When Do Varicoceles Need to be Treated?

Conservative Measures: There are no medications that can make a varicocele go away. In obese men, weight loss may decrease the severity of the varicocele and improve pain symptoms. Compression and scrotal elevation with a jock strap or similar device may help alleviate symptoms to some degree, but this is not a reliable, sustainable, or definitive treatment for varicocele. Observation will typically lead to no improvement or worsening of varicocele symptoms.

Surgery vs Embolization: Treatment options for scrotal varicoceles include varicocelectomy and embolization. There are multiple approaches to the surgical treatment of varicocele in men, including microscopic, laparoscopic, open, and robotic varicocele repair. Studies have shown that the most effective treatment option for varicocele repair is microscopic varicocelectomy, which provides the least invasive treatment option with fast recovery and the least risk of complications.

Our Approach to Treatment: We perform microscopic varicocelectomy at New York Urology Specialists.

Treatment of Scrotal Pain Due To Varicocele

Left-sided varicocele is most common. Some men present with a palpable left varicocele and nonpalpable small right varicocele that is discovered incidentally on the scrotal color Doppler ultrasound. If pain is only present on the left side, there is no need to treat the right side. Some men, however, experience pain on both sides, typically worse on the left side. We have found that most of the time when there is a subclinical right varicocele and predominantly left-sided pain, correction of the clinically significant left varicocele leads to resolution of the right-sided pain as well.

Advantages of Microscopic Varicocelectomy

The main advantage of microscopic varicocelectomy is the ability to effectively treat all sources of the varicocele, including varicose veins originating in the gubernaculum, which cannot be treated through embolization. Microscopic varicocelectomy is associated with a greater than 95 percent success rate in effectively treating scrotal varicocele. It is also associated with the lowest rate of hydrocele formation (less than 5-6 percent). The advantages of microscopic varicocelectomy performed through a subinguinal incision include quick recovery and absence of the risks of laparoscopy including injury to the bowel and adhesions.

Preparation for Varicocele Repair (Varicocelectomy)

We usually perform microscopic varicocelectomy in a surgical center or hospital. The procedure is performed under general anesthesia.

Diet: Patients need to fast for at least 8 hours prior to the surgery.  After the procedure, patients may resume a regular diet.

Medications: Patients are advised to inform the urologist about all the prescription and OTC medications they take. On the morning of the procedure, all medications (except blood thinners) should be taken with a small sip of water. The urologist will discuss if and when blood thinners (Coumadin) need to be stopped in preparation for the surgery.

Shaving: We do not advise patients to shave at home prior to the procedure. If needed, we will shave you in the operating suite. This minimizes the risk of infection.

What to Expect After Varicocele Repair?

Recovery from varicocele repair is fairly quick and relatively painless. Some mild pain or discomfort and slight bruising and swelling of the scrotum may be present. These signs and symptoms typically disappear completely in 3-4 weeks.

Wound Care: No special wound care is needed. We use resorbable stitches which are typically absorbed within 3-4 weeks of the procedure. If scrotal swelling is present, it typically goes away 3-4 weeks after microscopic varicocelectomy. A scrotal support is advised for the first 2-3 weeks after varicocele repair.

Activity: We advise patients to avoid strenuous activities, such as weightlifting or running, for 3 weeks after the procedure; after that, activities can be resumed as tolerated.

Return to Work: Patients are usually able to return to work and their normal routine 2-3 days after microscopic surgery.

Showering: Patients may shower the same day after the procedure. 

Beach and Swimming: Patients may go to the beach or swimming 2 weeks after the procedure, as long as the incision is healing well. 

Sex After Varicocele Repair: We advise no sexual activity for 3 weeks after microscopic varicocelectomy.

Common Risks and Complications of Varicocelectomy

In general, microscopic varicocelectomy has an excellent safety profile. As with any surgical procedure, there are small risks associated with the surgery.

Infection and Hematoma: Microscopic varicocelectomy is associated with a low risk of infection (less than 1 percent) and low risk of bleeding or hematoma (less than 3-5 percent).

Recurrence: The success rate of microscopic varicocelectomy is greater than 95 percent with a less than 5 percent risk of recurrence. 

Infertility: There is a small risk of infertility due to injury to the vas deferens, but this is very rare (occurs in less than 1 percent of patients). Our highly experienced surgeons at New York Urology Specialists take extreme care to identify and preserve the vas deferens and the testicular artery and protect these structures from injury during the surgery. 

Hydrocele: Less than 5-6 percent of men develop a clinically significant hydrocele after varicocele repair.


If you have any questions about varicocele treatment, schedule a consultation, contact us or call 1-(212) 204-6300.  We have excellent reviews from patients and their partners. 

We offer affordable, highest-quality urology care with or without insurance.   Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.

Dr. Alex Shteynshlyuger is a board-certified urologist, who specializes in all aspects of care for sexual problems in men including ED, premature ejaculation and other sexual concerns.  He has successfully treated hundreds of men with sexual problems including ED and poor libido.


Varicoceles are Treatable in Nearly Every Man

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of scrotal varicoceles in men.  We understand the challenges that ED creates for our patients, their relationships and their self-esteem.  We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.

Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED.  We offer medical and surgical treatment for erectile dysfunction.

We Treat Some of the Most Complex Health Problems in Men Including:

Schedule an Appointment with Dr. Shteynshlyuger:

Call today: (646) 663-5211 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urological problems in men using modern effective and proven treatment methods.  He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.

 

 

 

 

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