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Varicocele

Definition


Disease: Varicocele Varicocele
Category: Surgical diseases

Disease Definition:

A varicocele resembles a varicose vein that could occur in the leg. A varicocele is an enlargement of the veins within the scrotum, the loose bag holding the testicles. Even though not all varicoceles affect sperm production, still they are a common cause of decreased sperm quality and low sperm production. Shrinking of the testicles may also result from varicoceles. Luckily, most varicoceles can be easily diagnosed and can be surgically repaired in case they cause any symptoms. Varicoceles usually develop over time.
 

Work Group:


Symptoms, Causes

Symptoms:

Although a varicocele causes pain in some rare cases, but usually, no signs or symptoms are produced. The pain might:

  • Increase with sitting, standing or physical exertion, especially over long periods
  • Be relieved when lying on the back
  • Vary from dull discomfort, a feeling of heaviness, to sharp
  • Get worse over the course of a day

 

Varicoceles might expand and become more noticeable over time.
A varicocele is usually discovered throughout a fertility evaluation or a routine physical exam, since it often causes no signs and symptoms. In the case of discovering a mass on the scrotum or experiencing any pain or swelling in the scrotum, the person should see a doctor. Various situations could cause a scrotal mass or testicular pain, some of which need immediate treatment.
 

Causes:

Blood is carried to and from the testicles through the spermatic cord. What exactly causes varicoceles is not clear, but several experts believe a varicocele forms when the valves inside the veins in the cord prevent the blood from flowing properly. The vein widens or dilates due to the resulting backup. During puberty is when a varicocele usually forms. Probably due to the position of the left testicular vein, most varicoceles develop on the left side. Yet, the sperm production in both of the testicles can be affected by a varicocele that occurs in one testicle. Being between the ages of 15 and 25 increases the risk of varicoceles.
 

Complications

Complications:

Some of the things that may be caused by a varicocele are:

 

Shrinkage of the affected testicle (atrophy): 

The tubules that produce sperm are found in the bulk of the testicle. The testicle will become softened and shrunk in case a varicocele damages the bulk of the testicle. Blood pools in the veins due to this malfunctioning, resulting in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage; however, what causes the testicle to shrink is still not known.

 

Infertility: 

How varicoceles affect fertility isn’t certain. To help maintain the proper temperature for optimal sperm production, the testicular veins cool blood in the testicular artery. A varicocele may keep the local temperature too high by blocking blood flow, a thing that affects the formation and movement (motility) of sperm.
 

Treatments:

While the patient might undergo varicocele repair when experiencing pain, infertility or testicular atrophy, but treatment might not be needed for varicocele in other cases. Sealing off the affected vein to redirect the blood flow into normal veins is the goal of surgery. Yet, it’s not certain what the effects of varicocele repair will be on fertility. Abnormal semen analysis results, progressive testicular atrophy and pain are the indications for repairing a varicocele in adolescence. However, it’s not certain whether the patient should have varicocele repaired at adolescence, when they usually develop. Repairing a varicocele has relatively few risks, such as: 

  • Buildup of fluid around the testicles (hydrocele)
  • Damage to an artery
  • Recurrence of varicoceles

 

Some of the methods through which varicoceles may be repaired include: 

 

Open surgery:

This treatment is the most common one, often done on an outpatient basis using local or general anesthetic. The surgeon most commonly approaches the vein through the groin (transinuinal), but it’s still possible to cut an incision below the groin or in the abdomen. Progress in varicocele repair has led to a reduction of post-surgical complications. One advance is the use of Doppler ultrasound that helps in guiding the procedure. Another is the use of the surgical microscope, enabling the surgeon to see the treatment area better during surgery. After two days, the patient might go back to his normal nonstrenous activities. After two weeks, he could return to more strenuous activity such as exercising as long as he is not uncomfortable. Usually, only mild pain is caused by this surgery. For the first two days after surgery, the patient may be prescribed pain medications. After that, to relieve any discomfort, he may be advised taking over-the-counter painkillers, including ibuprofen or acetaminophen. The patient may be advised not to have any sexual intercourse for a week’s time. After the surgery, the patient will have to wait three or four months to get a semen analysis to determine whether the varicocele repair was successful in restoring the fertility because it takes about 72 days for sperm to generate.

 

Laparoscopic surgery: 

In this procedure that requires general anesthetic, to see and repair the varicocele, the surgeon makes a small incision in the patient’s abdomen and passes a tiny instrument through the incision. However, because this procedure poses more risk while offering little advantage, it is not used commonly.

 

Percutaneous embolization: 

In this procedure, a radiologist inserts a tube into a vein in the groin or neck through which instruments could be passed. While seeing the enlarged veins on a monitor, the doctor will release coils or balloons to create a blockage in the testicular veins, interrupting the blood flow and thus repairing the varicocele. This procedure uses sedation and might take many hours. Because this procedure offers little advantage and poses greater risks than open surgery, it is performed commonly.
 

Prognosis:

Not available

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