What is Varicocele?

Varicocele is the medical name for the swelling and enlargement of the veins in the scrotum, which is the loose skin bag that protects the testicles in men. Varicocele is similar to the “varicose veins” that can be seen in the legs.

Cases occur in the upper part of the testicles, usually in the left testis. Individuals may not be able to see the varicocele when lying down, but it may become visible when standing up. When touched by hand, the bag may feel as if there are plastic pipes or worms in it.

Varicocele is a fairly common medical condition and usually affects young men. This problem can be seen in 10 to 15% of men. Varicocele may not cause a medical problem by itself, but if it does cause problems, it would be best to consult a urologist.

Varicoceles are a common cause of low sperm production and reduced sperm quality to amounts that can cause infertility. However, sperm production is not affected in all cases of varicocele. Varicocele can cause the testicles not to develop normally or shrink, it is also one of the causes of infertility.

Most varicoceles develop over time. However, in most cases, varicocele is easy to diagnose and, again, in the vast majority of cases, no treatment is needed. Varicocele will only be treated if it causes symptoms, and the treatment is usually surgical.

What Causes Varicocele?

Medical professionals have not yet reached a definitive conclusion as to why varicocele occurs. It is thought to be caused by a problem with blood flow in the spermatic cord, where blood flows to and from the testicles.

Experts have concluded that when the valves that control the flow in the veins in the spermatic cord prevent proper blood flow, the blood pools and causes the veins to dilate.

This backward collection of blood can both cause damage to the testicles and cause a decrease in male fertility.

Varicocele usually occurs in boys during puberty. Under normal conditions, since the left testis is positioned lower than the right, it is usually observed to be found on the left testis vein.

While varicocele cases are seen on the left testicular vein in 90% and in both testicles with a rate of 9%, the remaining few cases are diagnosed in the right testis. A specific risk factor leading to the development of varicocele has not been identified.

What are the Symptoms of Varicocele?

A varicocele usually does not cause any signs or symptoms except its form. Rarely, it can cause pain. Varicocele pain can range from mild discomfort to sharp pain, and may increase with prolonged standing and physical exertion.

There may be an increase in the level of pain felt from morning to evening. Individuals may feel better when they lie on their back. In addition to pain, it can cause a decrease in male fertility.

Varicoceles may become more prominent over time. It is stated that in many cases it looks like a plastic pipe or a bag full of worms. It can cause swelling, almost always in the left testis.

However, asymptomatic varicoceles may generally go undetected if they are not detected during a fertility evaluation or a routine physical examination. Individuals who experience pain or swelling in the scrotum, feel a mass in the scrotum, notice that their testicles are of different sizes, history of varicocele in their youth, or have problems with conceiving a child should definitely consult a doctor. There are many medical conditions that cause scrotal masses or testicular pain, some of which require immediate treatment.

What are the Complications of Varicocele?

There are two general complications that varicocele can cause apart from pain:

Shrinkage or atrophy of the affected testis. In human anatomy, most of the testicles consist of tubules that produce sperm. If the testicles are damaged due to varicocele, they will shrink and begin to soften. Although the reasons behind this shrinkage are not fully known, it is suggested that blood accumulates in the vessels due to problematic valves, which increases the blood pressure in the vessels and causes the surrounding tissues to be exposed to toxins that can cause damage.

Infertility: Varicoceles can keep the local temperature in or around the testicle too high, affecting sperm formation, sperm motility, and preventing them from performing their functions due to inability to thermoregulate.

How is Varicocele Diagnosed?

The doctor will perform a physical examination on the individual's testicles, which can reveal any non-tender mass that feels like a bag of worms when touched.

If the varicocele mass is large enough, the individual or the doctor can easily feel this mass. However, if the mass is not large enough, the doctor may ask the individual to stand up, take a deep breath, close their mouth and nose and then try to force air out in order to increase the pressure.

This is called the Valsalva maneuver and it helps to feel veins by enlarging them.

With the help of the Valsalva maneuver, varicocele is evaluated and graded.

Grade 1: Varicocele in which no symptoms can be observed, but can be palpated during the Valsalva maneuver.

Grade 2: Varicocele, which is mildly observable and in which the veins become clearly visible as a result of the Valsalva maneuver.

Grade 3: Varicocele with clearly visible veins without the need for Valsalva maneuver.

If the physical examination is not sufficient, the doctor may order an ultrasound test of the scrotum. During the ultrasound test, sound waves are used to take pictures of the inside of the body.

This test is particularly useful for ruling out causes such as a varicocele or a tumor that may be causing the symptoms. It is especially helpful in determining how treatment should take place in young people.

How is Varicocele Treated?

Varicocele treatment may not be necessary for every individual. Many men with varicocele can become fathers without any treatment. Although treatment of varicocele usually results in improvement of sperm quality, it is not yet clear whether an untreated varicocele causes sperm quality to progressively worsen over time.

In the case of male infertility, varicocele treatment can improve infertility or improve sperm quality if techniques such as in vitro fertilization (IVF) are to be used. However, if the varicocele is painful, an operation to repair the varicocele may be considered, especially if it causes progressive testicular atrophy or abnormal sperm counts that progress through puberty.

How is Varicocele Surgery Performed?

The purpose of varicocele operation is to compress or close the affected vein to redirect blood flow to normal veins.

Varicocele repair is a relatively low-risk treatment. Among its risks:

  • Fluid accumulation around the testicles, named hydrocele
  • Recurrence of varicoceles
  • Infection
  • Vein damage

In general, two different methods can be applied for varicocele treatment:

Varicocelectomy is an open surgery performed in the hospital and is the generally preferred method in the treatment of varicocele. This treatment is usually performed on an outpatient basis in a single day and under the influence of general or local anesthesia. The urologist who will perform the operation will usually approach the affected vessels from the inguinal region but it is also possible to make an incision in the abdomen. The surgeon will then clamp or tie off the abnormal veins with the aid of a microscope. After this operation, blood flow is expected to bypass the abnormal vessels towards the normal ones.

Varicocele embolization is a less invasive procedure than open surgery. During this procedure, a small catheter, a thin, hollow plastic tube, is inserted into the inguinal vein. A coil is placed inside this catheter and the varicocele or the tissues are destroyed with an injection. The presence of this coil prevents blood from reaching abnormal vessels.

Life After Varicocele Surgery

Advances in modern medicine in varicocele repair have resulted in a reduction in postoperative complications.

One of the most important of these advances is the use of a surgical microscope, which allows the surgeon to see the treatment area better. Another is the use of Doppler ultrasound to help guide the varicocele repair procedure.

Thanks to these advances, those who have varicocele surgery can return to their normal life after two days and can start strenuous work such as exercising within two weeks unless there is an additional condition.

Although varicocele surgery pain is mild, it can last for several days or weeks. The doctor may prescribe pain medication for the patient to use for a limited period of time after surgery.

After the surgery, the doctor may recommend not to have sexual intercourse for a while. In the majority of cases, improvements in sperm quality can be seen with the help of semen analysis a few months after the surgery.

This is because it takes about three months for new sperm to develop. About half of the infertile men suffering from varicocele recover after surgical intervention. Surgical intervention also gives successful results for most young people who have slowed testicular growth.

How does the pain of varicocele improve?

If an individual has a varicocele that causes minor discomfort but does not affect their fertility, there are several methods that can be used to relieve pain:

Using over-the-counter pain relievers recommended by your doctor can help.

Wearing tight underwear or a tank top to reduce blood pressure and prevent dilation of the veins can have a similar effect to compression stockings, helping to relieve pain or discomfort in some cases.

Nutrition has nothing to do with the formation or treatment of varicocele. Only individuals with chronic constipation can indirectly benefit from constipation-solving fiber or olive oil diets. For this reason, it is stated by medical experts that there is no herbal varicocele treatment.

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