Varicocele Overview

Overview

A varicocele is defined as an enlargement of veins within the scrotum (loose bag of skin that holds the testicles). These enlarged veins are usually called pampiniform plexus. According to the studies, it is estimated that out of 100 males, approximately 10-15 males are diagnosed with varicocele. 

Causes for varicocele

The exact cause of the varicocele is not known. However, a few factors can contribute to the formation of varicocele. They include

• The spermatic cord usually consists of veins, arteries, and nerves that support the glands. Inadequate blood flow through the veins in the spermatic cord will result in causing varicocele
• Malfunctioning of the valves will result in causing varicocele
• Quick growth of testicles during puberty might cause varicocele
• Renal vein compression or increase in abdominal pressure

How common is varicocele?

Varicoceles is a very common condition seen in males. It accounts for about 15-20% of all adult men. In the majority of people, varicocele will go unnoticed throughout their lives, or most men are asymptomatic.

Symptoms of varicocele

The most common symptoms that are associated with varicocele are listed below:

• Pain- Most men complain of dull, aching pain or discomfort during standing or late in the day. Patients often feel comfort while lying down.
• Swelling or mass in the scrotum- The patient often complains of swelling in the scrotum or the presence of a hard lump in the scrotum.
• Infertility
• Abnormality in the size of the testicles

Diagnosis of varicocele

Whenever the patient notices any kind of abnormalities in the scrotal area, the patient should consult the doctor immediately. The doctor will record the history of the patient. To confirm the condition, the doctor will perform a couple of tests, which include:

• Physical examination- During the physical examination, the doctor will advise the patient to take a deep breath, hold the breath, and bear down, like the pressure during the bowel movement. This procedure is called the Valsalva maneuver. This maneuver often helps in diagnosing smaller varicoceles. 
• Investigational tests- they include an ultrasonography scan of the scrotum. This test will help us to confirm the varicocele.

Treatment of varicoceles

In most of the cases, varicoceles do not require any treatment. Treatment is often recommended for patients who encounter the symptoms mentioned above. 

• Surgery- it is often recommended in situations like- a testicle that shows delayed development, low sperm count, other sperm irregularities, and chronic pain that does not subside after painkillers. 

Varicocele can be operated through various approaches. They include:

• Microscopic varicocelectomy- The surgeon makes a small incision about 1cm above the scrotum during this procedure. With the help of a microscope, the surgeon ties off all the small veins, excluding the vas deference, artery, and lymphatic drainage. 
• Laparoscopic varicocelectomy- During this procedure, the surgeon makes small incisions in the abdomen and inserts trocars and a camera through the ports. The surgeon later performs a vein ligation process, closing the incisions with sutures. The procedure often lasts a shorter duration, and the patient can get discharged on the same or the next day. Percutaneous embolization- An interventional radiologist often performs this procedure. During this procedure, the radiologist inserts a contrast dye through the small tube with the help of X-ray guidance. The main aim of the procedure is to locate all the veins leading to varicocele. Coils are inserted to block the blood flow to the varicocele.  

What are the risks that are associated with surgery for varicocele?

The risks that are associated with varicocele surgery include:

• Hydrocele- accumulation of fluid in the scrotal area
• Recurrence of varicocele
• Chronic testicular pain
• Infections
• Hematoma- collection of blood around the testicles
• Damage to the adjacent structures

FAQ

1. What are the complications that are associated with varicocele?
A. The complications that are associated with varicocele include:

• Azoospermia- decrease in sperm count
• Infertility- According to the research studies, it is estimated that around 40% of those who are diagnosed with fertility problems have varicoceles. 
• Poor testicular health
• Low testosterone levels

2. Grades of varicocele
A. To assess the severity of the condition, varicoceles can be graded into four grades, which include:

• Grade 0- The patient often does not feel any abnormalities. It is usually diagnosed through an ultrasonography scan.
• Grade 1- During the Valsalva maneuver, the patient often notices a small lump in the scrotal area
• Grade 2- The swelling can be palpable without maneuvering.
• Grade 3- During this grade, the varicocele causes severe deformity in the scrotum. 

3. What are the natural ways by which varicocele can be treated at home?
A. The home remedies by which we can treat varicocele include:

• Rest
• Add fiber to the diet
• Avoid lifting heavy weights
• Avoid wearing tight underwear
• Use a jockstrap
• Ice pack if required
• Painkillers if required

4. Can varicocele be prevented?
A. Since the exact cause of varicocele is unknown, it cannot be prevented completely. 

References

1. https://www.webmd.com/men/what-is-varicocele#1-2
2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/varicocele
3. https://www.mayoclinic.org/diseases-conditions/varicocele/diagnosis-treatment/drc-20378772
4. https://www.mayoclinic.org/diseases-conditions/varicocele/diagnosis-treatment/drc-20378772
5. https://my.clevelandclinic.org/health/diseases/15239-varicocele