Varicocele Treatment: Surgery, Embolisation or Watchful Waiting?

Finding out you have a varicocele does not mean you need an operation. Most men never need varicocele treatment at all. For those who do, the choice is usually between surgery to tie off the faulty veins and embolisation, which blocks them from the inside. This guide explains who is offered treatment, how the options compare, what results to expect and what it may cost in Singapore.

If you are not sure what a varicocele is, read our varicocele overview first.

Does every varicocele need treatment?

No. A varicocele is a cluster of widened veins above the testicle, and around 15 in 100 men have one. Many cause no trouble for life. Doctors usually suggest watchful waiting when a varicocele:

• Causes no pain, or only a mild ache that simple measures control
• Is not linked to a fertility problem
• Is in a teenager whose testicles are growing normally

European urology guidelines advise against treating varicoceles that can only be seen on a scan, or in men whose semen test is normal, because treatment has not been shown to help in those groups.

When is treatment advised?

Treatment is usually considered in three situations.

Pain or discomfort

If a dull, dragging ache keeps coming back and affects work, sport or sleep, and simple measures have not helped, a repair may be offered. Doctors will first check that the pain is really coming from the varicocele, because other problems can cause scrotal pain. See varicocele symptoms for what typical varicocele pain feels like.

Fertility problems

Treatment may be suggested when a couple has had trouble conceiving, the man has a varicocele that can be felt on examination, his semen test is abnormal and there is no other clear cause. A 2021 Cochrane review found that treatment may improve the chance of pregnancy, but it could not confirm an effect on live births. Fertility specialists usually look at both partners before deciding. We cover this in more detail in varicocele and fertility.

A teenager’s testicle that is not growing

In adolescents, the main reason to treat is a testicle on the affected side that stays noticeably smaller than the other, confirmed on repeat checks some months apart, or an abnormal semen test in older teens.

Varicocele treatment without surgery

Several simple measures can ease a mild ache:

• Supportive underwear or a jockstrap for varicocele discomfort, particularly during exercise or long days standing
• Lying down when the ache builds
• Cold packs wrapped in a cloth, for short periods
• Over-the-counter pain relief, if it is safe for you
• Changing activities that trigger the ache, such as heavy lifting

These help symptoms but do not remove the varicocele. In studies, conservative measures gave lasting relief to only a minority of men with painful varicoceles. Some medicines that act on veins have been tried, but the evidence is limited. There is no good evidence that exercises, diets or supplements cure a varicocele.

Varicocele surgery (varicocelectomy)

In a varicocelectomy, a surgeon closes off the faulty veins so blood drains through healthy ones. It is usually a day-case operation under general anaesthetic. There are several approaches:

• Microsurgical varicocelectomy. A small cut is made in the groin, just above or below the crease. The surgeon uses an operating microscope to tie off the faulty veins while protecting the artery and lymph vessels. This approach has the lowest reported recurrence rates, around 1 to 2 in 100 in reviews, and the lowest rate of fluid build-up around the testicle (hydrocele).
• Laparoscopic (keyhole) surgery. The veins are tied off higher up, through small cuts in the tummy. It can treat both sides at once, but needs a general anaesthetic inside the abdomen and has higher reported rates of hydrocele.
• Open surgery higher in the tummy or groin without a microscope. This is used less often now because of higher recurrence rates.

Most men go home the same day. Expect soreness in the groin for a few days and some swelling. Many return to desk work within a week, but full recovery, including heavy exercise, can take several weeks. See recovery after varicocele treatment.

Varicocele embolisation

Embolisation is a non-surgical repair done by an interventional radiologist. A thin tube is passed through a needle hole in a vein in the groin, neck or arm, guided to the testicular vein using X-ray, and the vein is blocked from the inside with tiny coils or a sealing liquid. It is usually done under local anaesthetic, with or without light sedation, and takes about an hour.

Most men go home within a few hours and return to normal activities within a day or two. Recurrence rates are similar to most types of surgery, at around 5 to 10 in 100. In a small number of men, the vein cannot be reached, and surgery is then needed instead. For the full procedure, results and risks, see varicocele embolisation.

Which is better: surgery or embolisation?

Neither is right for everyone. In broad terms:

Guidelines note that microsurgery has the lowest recurrence and complication rates in specialist hands, while embolisation is less invasive and is often a good choice if a varicocele comes back after surgery. Overall complication rates between surgery and embolisation do not differ much. The best option depends on your anatomy, whether one or both sides are affected, your goals and the experience of the team. Ask your doctor how often they do the procedure and what their own results are.

What results can you expect?

• Pain. In studies, roughly 75 to 90 in 100 men treated for a painful varicocele had less pain or none afterwards. About 1 in 10 still had pain. Results are better when the ache follows the typical pattern of a varicocele.
• Fertility. Semen results often improve within three to six months, since sperm take about three months to develop. Treatment may raise the chance of pregnancy, but it is not guaranteed, and some couples still need fertility treatment.
• Teenagers. The affected testicle often catches up in size after repair, although evidence on long-term fertility benefit is limited.

Varicocele surgery cost in Singapore

The Ministry of Health publishes fee benchmarks. For microsurgical varicocelectomy (TOSP SH802V, table 3C), the private-sector surgeon fee benchmark is S$5,232 to S$7,194 including GST, and the anaesthetist fee benchmark is S$1,035.50 to S$1,308. Hospital charges for the operating theatre, ward and consumables are extra. Costs for embolisation depend on the hospital, imaging and materials used.

MediSave can be used for approved procedures up to a limit set for each surgical table, and Integrated Shield plans may cover part of the bill. Ask for an itemised estimate before treatment and check your coverage with your insurer.

When to see a doctor

Always get a new scrotal lump checked by a doctor, even if you think it is a varicocele. See a doctor too if you have an ache that keeps returning, a testicle that seems smaller, or you have been trying for a baby for a year without success. If you are deciding between treatments, our guide to finding a specialist explains who treats varicoceles.

Sudden, severe testicle pain is an emergency. It may be testicular torsion, which needs treatment within hours. Seek urgent help too for a hot, red, swollen scrotum with fever, or heavy bleeding or rapidly growing swelling after a procedure. In Singapore, call 995 in an emergency.

This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.