Varicoceles and Microsurgical Repair

A varicocele is abnormally dilated veins of the spermatic cord located in the scrotum, similar to varicose veins of the leg.  As an expert in male infertility and microsurgery, Dr. Lerner has diagnosed and repaired hundreds of varicoceles in men experiencing symptoms, as well as men who are asymptomatic but are found to have this issue during an evaluation.

The most popular theory is that varicoceles are caused by absent or abnormal valves in the veins draining from the testicles.  Since the reduced drainage of blood inside the scrotum can affect the temperature of the testis, the testis may be adversely affected from both a sperm production standpoint as well as testosterone production.

How does a man know if he has varicocele?

These varicose veins can often be seen with the naked eye and look like "a bag of worms."  More commonly, however, a varicocele is only detected upon examination by a physician.  Usually men find out they have varicocele if:

  • A physician finds it during an evaluation for infertility
  • They feel a mass in the scrotum either on their own or during routine exam and are concerned about future fertility
  • They experience pain in the scrotum
  • One testis is noticeably smaller than the other

How does varicocele affect male fertility?

Even if the varicocele is not causing any pain, there may be a concern for future fertility, as the elevated scrotal temperature caused by the dilated veins may hamper sperm production.  If a man has a diagnosed varicocele, definite evaluation and treatment by an experienced microsurgeon such as Dr. Brad Lerner who specializes in male infertility should be considered for the following reasons:

  • Associated bothersome scrotal pain
  • Decrease in the size of the testicle
  • Abnormal semen quality
  • Concern for future fertility


Most varicoceles do not require treatment unless they result in pain and/or infertility. Dr. Lerner can determine a course of action based on each individual case.

How is the varicocele repaired?

Dr. Brad Lerner performs a varicocele repair which involves stopping the abnormal blood flow in the varicose veins.  It is an outpatient procedure performed under general anesthesia or IV sedation through a small incision in the lower groin.  This procedure, when performed by an expert microsurgeon like Dr. Lerner, has the greatest chance of success with the fewest risks and lowest cost.