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Varicocele is a condition characterized by the enlargement of the veins located inside the scrotum – the loose sac that contains the testicles. These veins are responsible for transporting deoxygenated blood from the testicles. When the blood accumulates in the veins instead of flowing out of the scrotum, it results in the formation of a varicocele.
Usually beginning with adolescence, varicoceles grow over time. They may be uncomfortable or painful, although they frequently have no symptoms or complications. Varicoceles can vary in size, with larger ones sometimes having a resemblance to a sack of spaghetti and causing mild aches and discomfort. On the other hand, smaller varicoceles may not be easily detectable through either physical examination or visible appearance.
Varicoceles, in and of themselves, are generally not considered to be dangerous. However, if you are trying to conceive a biological child, having a varicocele can potentially pose a significant risk. A varicocele may result in poor testicular growth, inadequate sperm production, or other issues that could result in infertility. To address these issues, varicocele surgery may be suggested.
Symptoms
Varicoceles commonly occur on the left side of the scrotum and often do not present any noticeable symptoms. However, some potential signs and symptoms that may suggest the presence of a varicocele include:
- Pain. Standing or later in the day are more likely to cause a dull, throbbing pain or discomfort. Often, pain is relieved by lying down.
- A mass in the scrotum. A lump resembling a “bag of worms” may be discernible above the testicle if a varicocele is sufficiently large. A tiny varicocele can not be seen but may be detectable by touch.
- Varied sized testicles. The testicle that is afflicted could be visibly smaller than the other testicle.
- Infertility. While some varicoceles can make it difficult to become a parent, not all of them do.
Boys should get yearly check-ups to ensure the health and growth of their testicles. It’s crucial to make and adhere to these appointments.
Scrotal pain, swelling, or the presence of a mass can be indicative of various medical conditions, and it is recommended to seek medical attention if any of these symptoms are experienced. Visiting a doctor promptly can help ensure an accurate diagnosis and appropriate treatment plan.
Causes
Two testicular arteries, one on each side of the scrotum, supply the testicles with oxygen-rich blood. The two testicular veins function similarly, returning oxygen-depleted blood to the heart. The oxygen-depleted blood from the testicle is transported to the main testicular vein through a network of tiny veins (pampiniform plexus) in each side of the scrotum. The pampiniform plexus is enlarged in a varicocele.
A varicocele’s precise cause is uncertain. The veins’ internal valves, which are meant to keep blood flowing in the appropriate direction, may be a contributing factor. Additionally, the left testicular vein has a little different path than the right vein, which increases the likelihood of a blood flow issue on the left.
The accumulation of oxygen-depleted blood causes the network of veins dilates and develops the varicocele.
Risk factors
No obvious major risk factors for varicocele development are present. Varicoceles can occur in individuals of any age who possess testicles. Many medical experts believe that many varicoceles are present from birth. Varicoceles often become apparent during teenage years. It is thought that the increase in blood flow to the genital area during puberty may contribute to the development of varicoceles.
Complications
Your body may find it hard to control the temperature of the testicles if you have a varicocele. Toxin accumulation and oxidative damage may occur. The following issues could be exacerbated by these factors:
- Poor testicular health. A varicocele in a boy going through puberty may prevent the growth of the testicles, the production of hormones, and other aspects of the testicle’s health and function. A varicocele in a man may cause progressive shrinking as a result of tissue loss.
- Infertility. Not all varicoceles result in infertility. According to estimates, 10% to 20% of men with varicocele have trouble fathering a child. About 40% of men with infertility issues have a varicocele.
Diagnosis
A varicocele can be identified by visual and tactile examination of the scrotum by your doctor. Most likely, you’ll have examinations both lying down and standing up.
While in a standing position, your healthcare provider may request that you take a deep breath, hold it, and then apply pressure as if you were having a bowel movement. The Valsalva maneuver can make it simpler to evaluate a varicocele.
Imaging test
You might be asked to undergo an ultrasound examination by your doctor. Using high-frequency sound waves, ultrasound can provide images of the internal organs and other body parts. These pictures could be used for:
- Identify the varicocele or confirm the diagnosis.
- Rule out any other illness as a potential source of the signs or symptoms.
- Find any lesions or other factors preventing blood flow.
Treatment
Most of the time, a varicocele doesn’t require treatment. The treatment approach for a male with infertility may include varicocele surgery to repair the condition.
Medical professionals may recommend annual examinations for teenagers or young adults who are not actively seeking reproductive therapy to monitor any changes in their varicocele. Surgery may be recommended in the following situations:
- Chronic pain that is not controlled by painkillers
- A testicle that exhibits delayed growth
- Low sperm count or other abnormalities of the sperm (typically only examined in adults)
Surgery
Surgery’s goal is to close off the damaged vein and reroute blood flow to healthy veins. This is possible because the scrotum is supplied with blood flow by two additional artery and vein networks.
Results of treatment could include the following:
- The impacted testicle may eventually grow back to its normal size. The testicle’s development may “catch up” in the case of a teenager.
- In vitro fertilization (IVF) semen quality or fertility may be improved through surgery.
- Sperm counts could increase, and sperm abnormalities could be fixed.
Surgical procedures
By stitching or clipping the vein shut, your surgeon can block the flow of blood through the testicular vein. Today, two approaches are frequently used. Both surgeries are outpatient and call for general anesthesia; you can typically return home the same day. The steps consist of:
- Microscopic varicocelectomy. A small incision is made by the surgeon below the groin. The surgeon locates and ligates a number of tiny veins using a microscope. The operation typically takes two to three hours.
- Laparoscopic varicocelectomy. Using a video camera and surgical instruments connected to tubes that pass through a few very small incisions in the lower abdomen, the surgeon performs the procedure. There are fewer veins to ligate above the groin because the network of veins is less intricate. Typically, the operation takes 30 to 40 minutes.
Recovery
Although the pain from this procedure is typically moderate, it could last for several days or weeks. Following surgery, your doctor could recommend pain medication for a short duration. After that, your doctor might suggest that you take an over-the-counter pain reliever to ease your discomfort, such as acetaminophen or ibuprofen.
After surgery, you’ll probably be able to go back to work a week later and start exercising again two weeks later. Ask your surgeon when you can resume your normal activities or when you can engage in sexual activity without risk.
