Varicocele-expansion of the veins of the cluster-like plexus of the spermatic cord of the testicle. Varicocele usually appears in the left half of the scrotum, which is explained by the confluence of the left testicular vein at right angles to the renal vein. Rarely there is a bilateral or right-sided varicocele.

There are several ways to classify varicocele by degree: 

  • Grade I: dilated veins in the scrotum are not visible and are not palpable, except for their expansion during the Valsalva test (straining test), or the dilated veins of the cluster plexus extend to the upper pole of the testicle
  • Grade II: dilated veins in the scrotum are not visible, but are determined by palpation, or dilated veins of the cluster plexus extend to the middle third of the testicle
  • Grade III: dilated veins are visible on visual inspection-they protrude through the skin of the scrotum and are easily palpated, or dilated veins of the cluster plexus extend to the lower pole of the testicle

Symptoms and clinical manifestations

Varicocele may or may not cause subjective sensations in patients. More often, they are expressed as various pain sensations in the corresponding side of the scrotum. Prolonged stagnation of venous blood leads to ischemia, the development of sclerotic changes in the testicle and its hypotrophy (reduction). Varicocele can lead to impaired differentiation of the spermatogenic epithelium and damage to the hematotesticular barrier. Autoimmune aggression develops, which in the future may be manifested by a decrease in total spermatogenesis and the development of infertility. These changes are detected in the analysis of the ejaculate-in the spermogram, the most characteristic changes are asthenozoospermia (decreased sperm motility) or teratozoospermia (decreased number of normal sperm), or a combination of these two conditions.


The diagnosis of varicocele is not difficult. As a rule, it is enough to consult a urologist and perform an ultrasound examination of the scrotal organs. Varicocele is common: according to various studies, the frequency of varicocele in the male population varies from 20 to 30 %. But not all cases require surgical treatment.

Do I need an operation?

To do this, the doctor should carefully palpate the organs of the scrotum, and necessarily both in the patient's lying and standing position. At the same time, the doctor determines how pronounced the expansion of the veins is, whether there is a decrease in the size of the testicles, whether their consistency is changed. It is mandatory to perform ultrasound of the scrotal organs with CDK (Dopplerography), that is, a special method that allows you to assess the blood flow in the vessels, also in the lying and standing position and when straining.

Since spermatozoa are formed in the testicles, then with a significant violation of the blood supply in the testicles due to varicocele, the number of spermatozoa, their quality, and sperm motility can decrease.

Consequently, infertility may occur in patients with varicocele. If there are violations in the spermogram and the varicocele is determined,then in the vast majority of cases, the operation is indicated.

Sometimes,to determine the indications for surgery, the doctor needs to know about the level of sex hormones.

What is the treatment of varicocele?

The most effective method of treating varicocele is surgical treatment. That is, drugs for varicocele can not be cured, but you can only temporarily eliminate its symptoms. In the urology department of the MCSC, the most modern method of surgical treatment of varicocele is successfully used - the micro-surgical method of treatment of varicocele, or microsurgical resection of the testicular vein from the sub-inguinal access according to Marmara. To date, this is the most effective and minimally invasive method of surgical treatment of varicocele, which has been proven by numerous studies. 

Why is it microsurgical? 

Because to perform this operation, special surgical microsurgical instruments and magnifying glasses-microscopes are used, which allow the operating urologist to isolate and bind only the veins, without touching the artery that feeds the testicle, the lymphatic ducts and the vas deferens, thereby reducing the possibility of complications and relapse of the disease to a minimum.

Marmara surgery can be performed under both local and general anesthesia. In the vast majority of cases, general anesthesia is not required. The operation is performed with a 2-3 cm incision in the groin area and is painless. After the operation, the patient usually stays in the clinic for 1-2 days. Special restrictions in the postoperative period are not required, the patient returns to his normal activity after a few hours. The postoperative suture is almost invisible.

So, the advantages of the microsurgical operation of Marmara in varicocele:

  • Minimum incision (about 2-3 cm)

  • Minimal preparation for the operation

  • Preservation of the testicular artery and lymphatic ducts

  • A large percentage of improvement in spermogram parameters, including an increase in sperm motility, an improvement in sperm quality, and, consequently, the restoration of fertility (the ability to conceive)

  • Minimal risk of relapse, even compared to laparoscopic surgery
  • Minimal risk of complications, including the development of dropsy (hydrocele)

In the conditions of the urological department of the MCSC, the Marmara operation is possible in the shortest possible time. Consultation of an experienced doctor, ultrasound of the scrotal organs with CDK, tests necessary for surgical treatment can be passed in one day.

We have many years of experience in the treatment of varicocele, including experience in performing Marmara surgery. We know that patients with varicocele are young, active, working men, so we will do everything to ensure that the patient returns to his normal life as soon as possible. In the vast majority of cases, this is possible after 1-2 days.

GBUZ Moscow Clinical Scientific Center named after Loginov MHD