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Varicocele


A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the scrotum, the loose bag of skin that holds your testicles. A varicocele is similar to a varicose vein that can occur in your leg.

Dr. HajMurad will diagnose your condition and plan a treatment that best fit your condition

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Definition
A Varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the scrotum, the loose bag of skin that holds your testicles. A Varicocele is similar to a varicose vein that can occur in your leg.

Varicocele are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all Varicocele affect sperm production. Varicocele can also cause testicles to shrink.

Most Varicocele develop over time. Fortunately, most Varicocele are easy to diagnose and many don't need treatment. If a Varicocele causes symptoms, it often can be repaired surgically.
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 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.

Because a varicocele usually causes no symptoms, it often requires no treatment. Varicoceles may be discovered during a fertility evaluation or a routine physical exam.

However, if you experience pain or swelling in your scrotum or you discover a mass on your scrotum or you're having problems with fertility, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.
Causes
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). This may then result in damage to the testicle and result in worsened fertility.

Varicocele often form during puberty. Varicocele 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.
Risk factors
There don't appear to be any significant risk factors for developing a Varicocele. However, some research suggests that being overweight may increase your risk.
Tests and 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.
Treatments and drugs
Varicocele treatment may not be necessary. However, if your varicocele causes pain, testicular atrophy or infertility, or if you are considering assisted reproductive techniques, you may want to undergo varicocele repair. The purpose of surgery is to seal off affected veins to redirect the blood flow into normal veins. In cases of male infertility, treatment of a Varicocele may improve or cure the infertility or improve the quality of sperm if techniques such as in-vitro fertilization are to be used.

Although Varicocele typically develop in adolescence, it's less clear whether you should have varicocele repair at that time. Indications for repairing a Varicocele in adolescence include progressive testicular atrophy, pain or abnormal semen analysis results.

Varicocele repair presents relatively few risks, which may include:
  • Buildup of fluid around the testicles (hydrocele)
  • Recurrence of Varicocele
  • Damage to an artery
Repair methods include:
  • Open surgery.

    This treatment usually is done on an outpatient basis, using general anesthetic or local anesthetic. Commonly, your surgeon will approach the vein through your groin (transinguinal), but it's also possible to make an incision in your abdomen or below your groin.

    Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.

    You may be able to return to normal, nonstrenous activities after two days. As long as you're not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.

    Pain from this surgery generally is mild. Your doctor may prescribe pain medication for the first two days after surgery. After that, your doctor may advise you to take over-the-counter (OTC) painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to relieve discomfort.

    Your doctor may advise you not to have sex for one to two weeks. You'll have to wait three or four months after surgery to get a semen analysis to determine whether the varicocele repair was successful in restoring or improving your fertility. Open surgery has the highest success rates when compared to other surgical methods.

  • Laparoscopic surgery.

    Your surgeon makes a small incision in your abdomen and passes a tiny instrument through the incision to see and to repair the Varicocele. This procedure requires general anesthesia.

  • Percutaneous embolization.

    A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the Varicocele. This procedure is done with local anesthesia on an outpatient basis. This procedure isn't as widely used as surgery.


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