Varicocele is defined as the enlargement of the veins in the scrotum, representing a common cause for reduced sperm production and a smaller amount of sperm, which can cause infertility. Although it does not often require treatment, in severe cases it requires surgery.
What is varicocele and what are its symptoms?
A varicocele occurs when the veins inside the scrotum enlarge, called pampiniform plexuses (they have the role of cooling the arterial blood before reaching the sperm). Statistically, 10-15% of men have varicocele, which is similar to varicose veins that occur in the legs.
It should be noted that not all the forms of varicocele affect sperm production, and can cause an inability for the testicles to develop normally or lead to their shrinkage. In most cases varicocele develops over time and does not require treatment; however, if symptoms are present, surgery may be performed.
There are usually no symptoms of varicocele, rarely causing pain; when it occurs, it can range from sharp to discomfort, increases when the body is standing or on physical exertion (especially after long periods of time), worsens during the day, improves when the body is lying on its back. It should be noted that over time the varicocele can become larger and more noticeable, causing inflammation of the testicle, almost always on the left side; it also affects fertility.
If you notice pain or inflammation in the scrotum, a mass in the testicle, testicles of different sizes, fertility problems you should go to the doctor; there are other conditions that can lead to these symptoms, some requiring emergency treatment.
Causes for varicocele
The exact cause for the appearance of varicocele has not been identified, but specialists believe that it is formed when the valves inside the veins present in the spermatic cord prevent the correct circulation of blood, appearing a dilation (enlargement) of them. Generally, varicocele occurs during puberty on the left side, due to the positioning of the left testicular vein.
Diagnosis for varicocele
The doctor will perform a physical examination, which may reveal a painless mass resembling a bag of worms; when it is large enough it feels palpable. For a smaller varicocele, the doctor asks the patient to stand, inhale and hold the inspiration while squatting (Valsalva maneuver), so that abnormal enlargements of the veins can be detected.
If the physical examination is not conclusive, a scrotal ultrasound may be required; This excludes other conditions that can lead to symptoms (differential diagnosis), such as a tumor that compresses the spermatic vein. The ultrasound diagnosis will reveal veins larger than 3 ml with blood circulating incorrectly during the Valsalva maneuver. There are several degrees for the classification of varicocele, depending on the size, from grade 1 to grade 3, grade 0 being classified as sublinic (not yet detectable).
Varicocele treatment
Treatment may not be necessary for varicocele, as many men manage to have children without treatment. But if there is pain, testicular atrophy, infertility or consider assisted reproduction techniques, surgery is needed. Its purpose is to seal the affected vein to redirect normal blood flow into the veins. There are several risks associated with surgery, namely the accumulation of fluid around the testicle (hydrocele), varicocele recurrence, infection, damage to an artery. Here are the ways in which varicocele can be repaired:
– Microscopic varicocelectomy – the vein is approached through the groin or subinguinal area, using Doppler ultrasound; the use of the surgical microscope helps to reduce post-operative complications. A 1 cm incision is made above the scrotum and the surgeon ligatures the small veins and avoids the vas deferens, testicular arteries and lymphatic drainage. The intervention lasts 2-3 hours and the patient can be discharged on the same day. Within 2 days the daily activities can be resumed, without physical effort (forbidden for 2 weeks); pain may be present a few days / weeks postoperatively, which is why analgesic medication is recommended. Also, sexual intercourse is forbidden for a period of time after the operation. The spermogram will improve in about 3 months.
– Laparoscopic varicocelectomy – through a small incision in the abdomen the surgeon inserts a laparoscope and performs ligation of the veins. Because there are fewer ligatures in the abdomen, the procedure takes less, respectively 30-40 minutes, the patient being discharged on the same day.
– Percutaneous embolization – a radiologist inserts a sheath and then a catheter at the level of the inguinal canal through which various instruments can be inserted. When enlarged veins are visualized, a special solution or healing metal spirals (coils) are released that create a blockage in the testicular veins. The procedure takes 45 minutes-1 hour. Daily activities can be resumed after 2 days, and physical exercises after 7-10 days.
Complications that can occur after varicocele include testicular atrophy (testicular shrinkage), low testosterone levels and infertility (due to increased temperature in and around the testicle, which affects the formation, motility and function of sperm).