What Men Should Know About Varicocele

Medically reviewed by

Dr. Shudhhatam Jain
General Surgery - Proctologist

What Men Should Know About Varicocele.

Varicocele is a condition of enlarged veins in the scrotum. There is no known cause, but fortunately, treatment plans are available.

Varicocele is the enlargement of veins in the loose bag of skin that holds the testicles. These veins carry deoxygenated blood from the testicles. When blood pools inside the veins instead of flowing freely out of the scrotum, it results in varicocele.

The onset of varicocele is often during puberty and it slowly develops over time. Apart from discomfort or pain, varicocele doesn’t cause any significant complications.

However, in some men, the presence of varicocele could result in poor testicle development and lower sperm count. This results in infertility. When varicocele creates problems in men, the best remedial method is surgery.

Causes of Varicocele

Oxygenated blood is carried to the testicles by two testicular arteries on either side of the scrotum. Similarly, deoxygenated blood is taken back to the heart by two testicular veins called Pampiniform Plexus on each side of the scrotum. Varicocele is caused when the Pampiniform Plexus enlarges, pooling the blood inside the veins. This results in poor circulation, which leads in infertility issues.

The exact cause of varicocele is still unknown. When the valves inside the veins malfunction and inhibit blood from moving in the correct direction, it results in unnecessary pooling of blood. The testicular vein on the left side is more prone to circulation problems because it follows a slightly different path than the right.

No known risk factors increase the likelihood of varicocele in men

Possible Complications due to Varicocele

Varicocele is not as common as getting varicose veins in the legs. Typically, ten to fifteen males out of a hundred may suffer from varicocele. Due to the difference in the male anatomy, varicocele is more likely on the left side. When varicocele is present, 4 out of 10 men have infertility. Sometimes, infertility may hit 8 out of 10 men after fathering the first child.

When varicocele starts in puberty, it may result in the shrinking of the left testicle. It can interfere with hormone production and affect the functioning of the testicle. Gradually, tissue loss may occur. Varicocele is not the primary reason for infertility. Also, the presence of varicocele doesn’t always result in infertility. However, about 40% of men with fertility issues suffer from varicocele.

Symptoms

The most common symptom of varicocele is dull aching pain. It can cause more discomfort while standing. Some men may experience pain late in the evening. Usually, lying down relieves this pain. When the varicocele is large, it can present itself like a mass. Usually the mass looks typically like a bag of worms and can be seen above the testicle. Smaller varicoceles can be noticed by touch.

Diagnosis

Annual wellness examinations for boys during and after puberty are essential to monitor the health and development of testicles. Varicocele is diagnosed with a regular exam by a doctor. When there is pain, swelling or mass in the scrotum, you must consult your doctor immediately.

Urologists can diagnose varicocele using a physical examination. Sometimes, an ultrasound test may be ordered to determine the size of the testicles. When varicocele needs treatment, the ultrasound test can help determine the right course of action.

Treatment

When varicocele doesn’t cause any problem, it is often left untreated. However, treatment is required if symptoms such as pain, slower growth of the left testicle, abnormal semen analysis, or infertility are experienced. No drugs or treatment is available for treating varicocele. Sometimes, embolization may help in relieving pain. However, the best and most permanent treatment is surgery.

What is Varicocele Surgery?

Varicocele surgery involves surgical methods to stop blood pooling in the Pampiniform Plexus veins. The surgery is performed under general anaesthesia. Following are the standard surgical approaches:.

    ●    Microscopic Varicocelectomy

The surgeon makes a 1 cm incision just above the testicle. The surgeon can then ligate all small veins using a microscope, leaving testicular arteries, vas deferens and lymphatic drainage. The microscopic procedure usually takes 2 to 3 hours, but the patient can go home on the same day.

    ●   Laparoscopic Varicocelectomy

The surgeon inserts thin tubes using pin holes in the abdomen for vein ligation. The laparoscopic method ligates only fewer veins in the abdomen and it takes about 30 to 40 minutes. In this method, the patient can be discharged on the same day. Both microscopic and laparoscopic surgeries have the same recovery period. There will be minimal pain and in most cases, there are no post-surgical complications. .

Usually, surgery corrects varicocele, but it may recur later. It can also result in hydrocele formation and fluid formation around testicles. 1 in 10 patients complains about persistent or recurrent varicocele after surgery.