Varicocele


Varicocele

Description, Causes and Risk Factors:

A varicocele is a collection of enlarged veins that drain either one or both testicles. It is located just above the affected testicle, in the upper scrotum. These veins are similar to varicose veins in the leg. As a result of being enlarged, these veins affect the blood circulation to the testicles. It is not necessary to have a varicocele on both sides to affect both testicles, since one varicocele can commonly affect both testicles.

Approximately 15% of all adult males have a varicocele. Of these men, about 20% have problems with infertility. Adolescents appear to have a similar rate of varicocele but their effect on fertility is not known.

Grades:

    Grade 1: The varicocele is only felt when the patient bears down.

  • Grade 2: The varicocele can be felt, but not seen.

  • Grade 3: The varicocele is large enough to be visible.

Your spermatic cord carries blood to and from your testicles. It's not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate).

Varicoceles often form during puberty. Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles.

The effect of a varicocele is mostly on the production of sperm and, subsequently, on fertility. The varicocele commonly lowers the number of sperm produced and the movement, or motility, of the sperm. The varicocele can also affect the shape, or morphology, of the sperm. All these changes can lead to a decrease in the ability of a man to impregnate his wife when he has a varicocele. A varicocele can also lead to pain in one or both testes and it can sometimes be associated with atrophy, or shrinking of the testis. There is no evidence that a varicocele affects a man's general health or shortens his life. It is not associated with the development of testicular cancer. The most common reason people seek treatment for a varicocele is for its affect on fertility.

The exact way in which the varicocele affects fertility remains a mystery. Most investigators believe that the varicocele alters the normal blood flow past the testicles by allowing venous blood to pool around the testicles. This is believed to alter the temperature of the testicles and subsequently decrease fertility. Whether this is the only or the correct reason for the effect of the varicocele on fertility remains to be proven.

Symptoms:

A varicocele often produces no signs or symptoms. Rarely, it may cause pain. The pain may:

    Vary from dull discomfort — a feeling of heaviness — to sharp.

  • Increase with sitting, standing or physical exertion, especially over long periods.

  • Worsen over the course of a day.

  • Be relieved when you lie on your back.

With time, varicoceles may enlarge and become more noticeable.

Diagnosis:

Your doctor will conduct a physical exam, which may reveal a twisted, nontender mass above your testicle that may feel like what's been described as a bag of worms. If it's large enough, your doctor will be able to feel it. If you have a smaller varicocele, your doctor may ask you to stand, take a deep breath and hold it while you bear down (Valsalva maneuver). This helps your doctor detect abnormal enlargement of the veins.

If the physical exam is inconclusive, your doctor may order a scrotal ultrasound. This test, which uses high-frequency sound waves to create precise images of structures inside your body, may be used to ensure there isn't another reason for your symptoms. One such condition is a tumor that compresses the spermatic vein.

Treatment:

There are multiple techniques for correcting a varicocele. All of the methods involve ligating (closing with sutures) the testicular veins. The 3 popular techniques are laparoscopic, retroperitoneal and microscopic subinguinal. All require small incisions. All carry a risk of varicocele recurrence (2% to 15%) and hydrocele (water in scrotum) formation (1% to 10%). The laparoscopic technique carries a very small risk (< 1%) of intra-abdominal organ injury or bleeding. Other smaller risks include testicular atrophy (shrinkage), wound infection and prolonged pain.

All procedures are done on an outpatient basis. A general anesthetic is required. The surgery lasts about one hour. The patient will go home 1 to 2 hours after surgery.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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