Varicocele

What is Varicocele?

Varicocele describes a condition with swollen and enlarged veins in the scrotum. These veins carry blood from the testicles that is low in oxygen and nutrients. Swelling can happen when blood flows backward in the veins. Varicoceles are like varicose veins in the leg. Varicoceles are common in prepubescent and adolescent boys. They are uncommon in boys younger than age 10 and rarely develop after adolescence. Most varicoceles are found only on the left side because of the way blood drains from the left testicle into the abdomen. In some cases, they can also develop above the right or in both testicles.

Varicoceles are present in 15% of the normal male population. Usually, varicoceles are not painful and do not need treatment. However, treatment might be advised if a varicocele:

  • is painful

  • causes a testicle to underdevelop or shrink (testicular atrophy)

  • potentially affects the ability to father children (fertility); varicoceles are found in up to 40% of patients with male factor infertility

  • in some cases, varicoceles can affect fertility by reducing blood flow and raising the temperature of the testicles. This can cause the testicles to produce fewer sperm, and sperm that is produced might not be healthy.

The Severity of a Varicocele Can be Classified into Three Grades:

1. Can be felt by hand only during straining

2. Can be felt by hand when relaxed

3. Can become clearly visible at a distance, even at complete rest

A Varicocele May Cause:

Shrinkage of the affected testicle (atrophy) and problems fathering children (infertility). With a varicocele, the testicle may be too warm. This can affect sperm formation, movement (motility), and function. However, most of the boys with a varicocele will have no fertility problems later in life.

Symptoms and Diagnosis of Varicoceles:

Varicoceles usually have no symptoms. In rare cases, it may cause pain, which may vary from sharp to dull discomfort in the scrotum, increase with standing or physical exertion, or worsen over the course of the day. The pain is often relieved when you lie on your back. Occasionally, you may notice a varicocele, or it may be noticed by your parents or by a physician during a routine physical examination or during a fertility evaluation at an older age.

How is the Diagnosis Made?

It is usually relatively simple to diagnose a varicocele. Your doctor will take a detailed medical history and ask questions about your symptoms, if any. Examination by a doctor is crucial to rule out or confirm a varicocele. Your doctor will carefully examine your external genitalia. A collection of swollen and tangled veins in the scrotum that can be felt more in the upright posture or during straining, suggests a varicocele. The swollen veins may feel like a “bag of worms”. Both testicles should be examined to compare their size. The testicle affected by varicocele is usually smaller.

Treatment of Varicoceles:

Surgery is the only way to treat varicoceles, but not all patients would benefit from surgery. Surgery may be recommended if: The affected testicle is small, there exist other conditions associated that could affect fertility, abnormal semen parameters (in older adolescents), pain, marked swelling, or physical discomfort is present. If none of these criteria apply, surgery is not needed. Annual doctor visits are important to monitor.

Surgery:

The surgical procedure blocks the enlarged veins from draining blood from the testicle. This blockage redirects the blood flow to healthy veins. This can be done: Through a small cut in the groin with the use of a surgical microscope. During surgery, the doctor will try to protect nearby structures called lymphatic vessels. These tiny structures are usually invisible to the naked eye. They carry lymph, a clear, yellowish liquid that collects in all parts of the body. If they are injured, lymph cannot flow properly, and complications can develop. This surgery, called lymphatic-sparing varicocelectomy, can lower the chance of complications. Angiographic occlusion is another method used to treat varicocele. It collapses the twisted vein with a special substance. This method does not usually require you to be asleep (general anesthesia) and is less invasive than laparoscopic surgery. However, it uses X-ray, so you are exposed to radiation.

After Surgery:

The patient may be able to return to normal, nonstrenuous activities after 2 days. As long as they are not uncomfortable, they may return to more strenuous activity, such as exercising, after 2–4 weeks. Pain from this surgery is usually mild but may continue for several days or weeks. The doctor may prescribe pain medication for a limited time after surgery. After that, the doctor may advise you to take over-the-counter medication like acetaminophen or ibuprofen. Wearing briefs or a jockstrap can also help by relieving pressure in the testicles. It will take several months after surgery before improvements in sperm quality can be seen with a semen analysis. This is because it takes approximately 3 months for new sperm to develop.

After varicocelectomy, improvement in semen quality occurs in up to 70% of patients and the pregnancy rate is as high as 40%. Correction of varicoceles also improves functional sperm defects such as reactive oxygen species and breaks in DNA. Varicocele treatment improves pregnancy and live birth rates among couples undergoing intrauterine insemination and in vitro fertilization; further, the chance of miscarriage is decreased if varicocelectomy is performed before assisted reproduction.