What is Varicocele? Definition
A varicocele is an enlarged vein within the scrotum, similar to varicose veins that can occur in the leg. Every male has a structure known as the spermatic cord, containing arteries, nerves, veins and tubes. These cords connect to the testicles and allow blood to circulate back and forth. The veins in this cord structure are the ones in charge of blood flow and contain valves that help regulate the process. When the valves fail the blood can end up flowing in reverse and cause the blood to back up or collect in pools within the veins. These clogged veins then stretch and become swollen, causing a varicocele. In most cases they are harmless, but can be associated with infertility because they have the potential to decrease sperm quality and production.
Quick Facts
- About 15 per cent of men have a
- Of men evaluated for infertility 40 per cent have a varicocele in at least one testicle.
- Varicoceles occur in about one in six males.
- They are more common in males aged 15-25.
Symptoms
Most men don’t develop symptoms but when they do occur it is most commonly during hot weather, after exercise or when they have been standing for an extended period of time. Possible signs include:
- A dull ache in the testicles.
- A heavy or dragging feeling in the scrotum.
- Dilated veins in the scrotum.
- Discomfort in the testicles or on a particular side of the scrotum.
- A smaller testicle on the side with the dilated veins.
Because these enlarged veins are usually harmless they can often fly under the radar. In the most extreme cases individuals may experience varicocele pain and swelling. If you experience these symptoms, see your doctor before taking anti-inflammatory or pain medicine.
How to Test for Varicoceles?
A diagnosis for varicoceles usually comes after a physical examination. Even if your doctor doesn’t see or feel these veins in an exam, it does not always mean you are in the clear. In some cases they may need to perform a scrotal ultrasound, which measures the spermatic veins and gives a detailed picture of the condition. Following a positive diagnosis, your doctor will classify the veins on a varicocele grading scale (from one to three).
- Grade I: Palpable to the touch when the patient exhales forcefully (valsalva maneuver).
- Grade II: Palpable to the touch even when the patient does not exhale.
- Grade III: The varicocele is causing a visible deformity.
Size does not matter when it comes to treatment. These options are instead based on the patient’s degree of discomfort or infertility issues.
Varicocele Infertility
About one-third of men who are nevaluated for infertility find they have varicoceles during examinations. According to a one study, of 540 infertile men with palpable varicoceles that underwent a varicocelectomy:
- A greater than 50 per cent increase in total motile sperm count was observed in 50 per cent of the patients.
- An overall spontaneous pregnancy rate of 36.6 per cent was achieved after the varicocelectomy with a mean time to conception of seven months (range 1 to 19).
- Of preoperative in-vitro fertilization/intracytoplasmic sperm injection (IVF and ICSI) candidates, 31 per cent became intrauterine insemination (IUI)
- Of all IUI candidates, 42 per cent gained the potential for spontaneous pregnancy.
- Microsurgical varicocelectomy has significant potential not only to obviate the need for assisted reproductive technology, but to shift the level of assisted reproductive technology needed to bypass male factor infertility.
These results show that surgery can significantly improve the plight of infertility caused in men with varicoceles. Talk to your doctor if you think this could be the cause behind your infertility issues and get tested.
Treatment of Varicoceles
Varicoceles are not always treated. Doctors typically only offer treatment options to men who are having fertility problems, pain or have the left testicle growing more slowly than the right side. There are no medications to treat varicocele pain and surgery is the main treatment solution. More than one surgery option is possible, but they all work to block blood flow in the pampiniform plexus veins.
- Open surgery: This surgery is performed through a single one-inch (2.54-centimeter) The surgeon will then use a magnifying glass or an operating microscope to inspect the veins. Individuals undergoing open surgery require local or general anesthesia.
- Laparoscopic surgery: Thin tubes are placed inside the body through a small incision. Carbon dioxide gas is then pumped inside the abdomen so the surgeon can see the organs. A laparoscope (a fiberoptic instrument connected to the monitor) is then inserted through the tubes so the surgeon can perform the operation.
- Percutaneous embolization: This operation is performed by a radiologist. First they place a tube into a vein in either the neck or groin. Next they check the enlarged vein using an X-ray. Coils or balloons are then opened through the tube to block the veins and halt the blood flow. This causes the varicocele to shrink. Embolisms are not the common treatment method and can cause problems such as the varicocele remaining/returning, the coil to move, or an infection can occur where the tube was placed.
Surgery treatments are usually effective, with most patients returning to normal activities after two days and with very little pain. In rare cases, there is the risk of damaging the testicular artery, causing the loss of a testicle, but this is not common.
