At the London Urology Collective, we provide expert assessment and management of varicocele in the context of male reproductive and sexual health. Our consultants specialise in andrology and reproductive urology, offering evidence-based evaluation, careful counselling, and modern surgical or radiological treatment where appropriate.
Our aim is to determine whether a varicocele is clinically significant, explain whether treatment is likely to be beneficial, and help you choose the most appropriate next step for your fertility, symptoms, and long-term testicular health.
Common causes of varicocele
A varicocele develops when the veins that drain blood from the testicle become enlarged and blood pools within them. This usually happens because the small valves inside the veins do not work efficiently, allowing blood to flow backwards and causing the veins to widen over time.
Varicoceles most commonly develop during puberty or early adult life and are often found on the left, due to the way the left testicular vein drains into the abdominal circulation. Some men have a varicocele on both sides..
Sometimes, a new varicocele developing later in life, particularly on the right side or associated with sudden swelling, may need further investigation to exclude pressure on the draining veins higher in the abdomen.
What to expect
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Medical history
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Physical examination focusing on the abdomen, testes, and scrotum
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Review of semen analysis results if relevant
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Hormone blood tests if relevant
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Scrotal ultrasound with Doppler assessment
Treatment options
Treatment depends on your symptoms, examination findings, fertility goals, and semen parameters, and may include:
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Observation or reassurance
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Pain management and supportive measures
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Fertility planning and coordination with reproductive specialists
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Microsurgical varicocele repair
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Varicocele embolisation
Treatment may be recommended in selected men with a clinically significant varicocele, abnormal semen parameters, and otherwise unexplained infertility, or in men with persistent scrotal discomfort thought to be related to the varicocele.
The aim of treatment is to seal or divide the veins while carefully preserving the arteries, lymphatics, and vas deferens. This can be achieved either by microsurgical varicocele repair or by radiological embolisation. Microsurgical treatment is performed through a small incision and uses magnification to identify and divide the abnormal veins precisely. Embolisation is a minimally invasive radiological procedure performed by passing a fine catheter into the affected veins and sealing them internally, usually with coils or a sclerosing agent.
Both treatments are generally performed as day-case procedures. Recovery is usually straightforward, and most men can return to light activity within a few days, although strenuous exercise and sexual activity should be avoided for a short period as advised by your specialist.
When to Seek Specialist Advice
You may benefit from a consultation if you experience:
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Persistent scrotal pain or discomfort (especially after standing or exertion)
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Noticeable swelling or “bag of worms” feeling in the scrotum
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Testicular heaviness or aching sensation
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Visible or enlarging veins in the scrotum
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Testicular size difference (possible atrophy)
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Fertility concerns or abnormal semen analysis
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Symptoms worsening over time
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Varicocele detected during adolescence (monitoring needed)
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Sudden onset of varicocele (especially on the right side) — urgent evaluation
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Symptoms significantly affecting daily activities or comfort
Early assessment can provide reassurance and allow timely treatment where needed.
Why Choose The London Urology collective
We combine leading clinical experience with up-to-date knowledge of both established and innovative therapies. All treatment options are discussed clearly, allowing you to make an informed choice that best fits your needs and long-term health.