Bilateral Varicocele: what it is, causes, symptoms and treatment

• Bilateral varicocele is the same as the usual varicocele, inflammation of the venous plexus that nourishes the testicle, with the difference that bilateral varicocele affects both testicles.
• One of the causes of bilateral varicocele in many cases is a retro peritoneal tumour or cirrhosis of the liver, although in others it is something congenital that occurs regularly.
• The only viable solution to bilateral varicocele is surgery.

Varicocele is a testicular pathology that consists of varicose dilation of the veins that drain blood to the testicles, following the same concept as varicose veins in the legs, seriously affecting testicular functionality and implying a high risk of loss of fertility and even a reduction in the size of the affected testicle, something that must be solved with varicocele surgery.

Varicocele usually appears only on the left side, but in other cases it can appear only on the right side or even on both sides, which is known as bilateral varicocele.

Although it is true that varicocele on the left side is the most common, it is also common to find men suffering from bilateral varicocele, which should be treated immediately because the chances of infertility and other associated problems increase considerably when both testicles are affected. Bilateral varicoceles occur in approximately one third of all diagnosed varicoceles.

The appearance of bilateral varicocele, especially right varicocele, is often due to the appearance of a retroperitoneal tumour or cirrhosis of the liver (a degenerative disease of the liver that produces an enlarged liver with an alteration in its normal functioning) that compresses the venous plexus (a group of arteries and veins) responsible for nourishing the testicle. To determine whether the varicocele is due to a retroperitoneal tumour or cirrhosis of the liver, the patient is placed lying down and it is observed whether the venous plexus remains dilated.

If sustained, it is very likely to be a tumour, liver cirrhosis or an intra-abdominal mass compressing the veins of the lower abdomen that has caused thrombosis in the venous plexus and further tests should be done to confirm this definitively.

On the other hand, in the vast majority of cases, it is a congenital problem that can cause the venous plexus to dilate and accumulate blood throughout life, disrupting normal testicular flow.

It is a relatively common problem and almost never presents symptoms in the patient, being diagnosed mostly during an examination by a urologist looking for fertility problems.

There are also various degrees of varicocele depending on how easy it is to diagnose or how severe it is.

As mentioned in the previous section, both bilateral varicocele and one-sided varicocele usually have no symptoms, although in a small number of cases the following symptoms are present:

• Feeling of heaviness in the area. This is one of the most common symptoms in cases of bilateral varicocele. It is due to pooling of blood in the veins of the venous plexus that nourishes each testicle.
• Discomfort during sexual activity. The patient feels discomfort in the testicular area during sexual intercourse.
• Reduction in testicular size. Due to lack of blood supply and reflux of unfiltered blood from the kidney, the testicle or testicles may atrophy and shrink considerably.
• Infertility. This is perhaps one of the most common triggers for the diagnosis of varicocele, as patients who come to the urologist with fertility problems often have undetected varicocele.

The only viable and definitive solution to solve varicocele, whether left, right or bilateral, is surgical treatment. 

There is no medication that can alleviate the problem and the only non-surgical option is to monitor the varicocele periodically, although surgery will always end up being necessary and it is recommended to treat it as soon as possible to avoid more serious complications such as the following:

• Continuous discomfort. This considerably reduces the patient's quality of life as they spend the day in pain in the area.
• Serious infertility problems. Due to the lack or insufficient blood supply, spermatogenesis (the process by which spermatozoa are formed inside the testicles) is affected and can lead to a reduction in the number of spermatozoa and even their deformation, increasing the chances of the foetus suffering genetic mutations that cause serious illnesses or disabilities.
• Reduced testicular size. This reduction in the size of the testicle or testicles in the case of bilateral varicocele is visible at first sight and is due to the accumulation of blood in the testicle that is not filtered by the kidneys, causing it to reduce in size and consequent atrophy.

In all these cases the only definitive solution is the varicocele operation, performed on both sides in the case of bilateral varicocele.

In this regard, if it is a bilateral varicocele and the surgery is performed on both at the same time, the recovery time is a little longer than if one is operated on first and then the other. Normally, both varicoceles are corrected in the same surgery, as patients usually prefer to undergo only one surgery.

One of the possible complications after varicocele surgery is the formation of what is known as a hydrocele, which is not a serious problem but may require a second surgery to solve it.