Male varicocele

Content

Introduction

Varicocele is an enlargement of the veins that are found inside the sac of skin that encloses the testicles (scrotum) and is similar to varicose veins that occur on the legs. It often causes a decrease in the quantity and quality of sperm that it can lead to infertility and it can also cause a reduced development of the testicles (read the Hoax).

Most varicoceles manifest over time, are easy to ascertain (diagnose), and in many cases require no cure (read the Hoax). If a varicocele produces symptoms (symptoms), it can be treated surgically.

Symptoms

Usually, varicocele causes neither signs nor disorders (symptoms). Rarely, it can cause pain which can:

  • vary from acute to deaf
  • increase when standing or after prolonged physical exertion
  • get worse over the course of the day
  • decrease while lying with the stomach up (supine position)

Over time, varicocele can increase in volume and become more noticeable. In young people it can compromise the production of sperm (read the Hoax).

Since varicocele often does not produce ailments (symptoms), no treatment is required. It can be discovered during a follow-up visit or a specialist visit for the evaluation of fertility (read the Hoax).

However, it is advisable to consult your family doctor if varicocele appears at a young age, the scrotum is swollen or painful, the testicles are of different sizes or there are fertility problems.Several diseases can cause a mass in the scrotum or pain in the testicles, and some require immediate treatment.

Causes

Many experts believe that varicocele forms when the valves within the veins of the funiculus, which carry blood to and from the testicles, prevent blood from flowing properly. The resulting reflux causes the veins to dilate and damage can occur. to the testicle and, consequently, fertility problems.

Varicoceles often form during the age of sexual development (puberty) and usually appear on the left side, most likely due to the position of the left testicular vein. However, having a varicocele in even one testicle can affect sperm production in both.

Risk factors
There appear to be no significant risk factors for developing a varicocele. However, some research suggests that being overweight may reduce risk while tall stature may increase it.

Diagnosis

Usually, the assessment (diagnosis) of varicocele takes place during a visit by the doctor andrologist, or urologist, who detects the presence of a painless mass above the testicle similar, on palpation, to a bag. If the varicocele is large enough, the doctor can look at it directly; otherwise, he may ask to stand up, inhale and hold the air while exerting pressure on it (Valsalva maneuver). This helps him to check if there is abnormal dilation of the veins.

In some cases, if the visit is not sufficient, the doctor may prescribe a testicular ultrasound, an investigation that uses high-frequency sound waves to create precise images of the internal structures of the body. It can be used to determine whether the cause of the disorders (symptoms) is varicocele or another disease such as, for example, a tumor that compresses the spermatic veins.

There are 4 levels of varicocele: I, II, III and IV degree. The indication on the need for treatment is given by the andrologist, or by the urologist with andrological skills, if varicocele is associated with an alteration in the quantity and quality of sperm, with testicular pain and if it is necessary to preserve fertility.

Complications

Varicocele can cause:

  • shrinking of the affected testicle (atrophy), most of the testicle is made up of sperm-producing tubules. When damaged, as can happen with varicocele, the testicle shrinks and softens. It is not clear what the cause is, one hypothesis is that there is a stagnation of blood and therefore an increase in pressure in the veins
  • infertility, varicocele can cause an excessive increase in local temperature around the testicle, affecting sperm production, motility and function

Therapy

Varicocele often does not need treatment (therapy). However, if pain, testicular atrophy, or infertility is present, or if you are considering assisted reproductive techniques, surgery is recommended.

The purpose of the surgery is to close the affected vein to redirect the blood flow in the normal veins. In cases of male infertility, varicocele treatment can even resolve it or, if you are using techniques such as in vitro fertilization (IVF), improve sperm quality.

Usually, varicocele develops in adolescence and causes a deterioration in the quantity and quality of sperm; however, many people continue to have sufficient sperm quality to produce children.

Progressive testicular atrophy, pain or abnormal seminal fluid examination results are clear indications for performing varicocele surgery in adolescence.Although varicocele treatment generally improves sperm characteristics, it is unclear whether an untreated varicocele leads to a progressive deterioration in sperm quality over the years.

Treating varicocele has few risks, including:

  • accumulation of fluid around the testicles (hydrocele)
  • recurrence (recurrence) of varicocele
  • testicular atrophy
  • infection
  • damage to an artery

Surgical treatments include:

  • open surgery, it is performed under general or local anesthesia, with a small incision of a few centimeters in the abdomen or at the level of the pubis, towards the groin. Post-operative complications are reduced thanks to the use of the surgical microscope which allows the surgeon to enlarge the operating field and, therefore, to better see the area to be operated on and to the Doppler ultrasound which helps to guide it. After just two days from the surgery you can return to normal daily activities and after two weeks you can resume the most demanding physical activities. The post-surgery pain is generally mild but can continue for several days or weeks. In this case, on prescription, it is possible to take pain medication. Your doctor may advise you to avoid sexual intercourse for a certain period of time. Most of the time, it will take several months after surgery before you can appreciate an improvement in sperm quality with the examination of the seminal fluid. In fact, spermatozoa take about three months to develop. Open surgery with the aid of a microscope and with the sub-groin approach has had the highest success rates compared to other surgical methods
  • laparoscopic surgery, the surgeon makes a small incision in the abdomen to insert a small instrument and locate and repair the varicocele. This procedure requires general anesthesia
  • percutaneous embolization, is performed on an outpatient basis under local anesthesia. Passing through the blood vessels, the radiologist reaches the testicular veins and burns them (cauterizes), interrupting the flow of blood and thus repairing the varicocele. This procedure is less common than surgery

Bibliography

Mayo Clinic. Varicocele (English)

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