VARICOCELE

A skin-covered sac that holds your testicles is known as a scrotum. Your scrotum also contains arteries and veins that deliver blood to your reproductive glands. The anatomy of the right and left side of your scrotum isn’t the same.

Varicocele is when there’s a vein abnormality (pampiniform plexus) in the scrotum. The veins within the scrotum become enlarged in varicocele.

Similar to varicose veins that develop in the leg, a varicocele only occurs in the scrotum. This can result in decreased sperm production and quality which in some cases may lead to infertility. It can also shrink the size of your testicles.

IS VARICOCELE COMMON?

Yes, varicoceles are common. They are found in 15% of the general male population. Varicoceles also affect around 15% of teenage boys. This condition generally forms during puberty and they occur more commonly found on the left side of your scrotum.

Varicoceles can form on both sides of your testicles. However, it’s extremely rare. Not all varicoceles affect sperm production.

SYMPTOMS

You may experience no symptoms associated with a varicocele. However, you might experience:

  • A lump in one of your testicles
  • Swelling in your scrotum
  • Visibly enlarged or twisted veins in your scrotum (often described as looking like a bag of worms)
  • A dull, recurring pain in your scrotum

TREATMENT

Treatment for varicocele may not be necessary. However, if it causes pain, testicular atrophy, infertility or if you are considering assisted reproductive techniques, you may want to undergo varicocele repair.

Surgery aims to seal off the affected vein to redirect the blood flow into normal veins. Treatment may improve or cure the infertility or improve the quality of sperm if techniques such as in vitro fertilization (IVF) are to be used.

Repair methods include:

OPEN SURGERY

Open surgery is usually performed on an outpatient basis during a general or local anesthetic. Normally, your surgeon will approach the vein through your groin (inguinal or subinguinal) but your surgeon may make an incision in your abdomen or below your groin.

Advances in varicocele repair have led to a reduction of post-surgical complications:

  • Surgical microscope: This enables your surgeon to see the treatment area better during surgery
  • Doppler ultrasound: This helps guide the procedure

You may be able to return to normal, nonstrenuous activities after two days. As long as you’re not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.

Pain experienced is normally mild but may continue for several days or weeks.  Pain medication may be prescribed for a limited period after surgery. After that, you may be advised to take over-the-counter (OTC) painkillers to relieve discomfort such as:

  • Acetaminophen (Tylenol, others)
  • Ibuprofen (Advil, Motrin IB, others)

You may be advised not to have sex for a period of time. It will often take several months after surgery before improvements in sperm quality can be seen with a semen analysis as it takes approximately 3 months for new sperm to develop.

A microscope and subinguinal approach has the highest success rates when compared with other surgical methods.

LAPAROSCOPIC SURGERY

This procedure requires general anaesthesia. A small incision in your abdomen will be made where a tiny instrument may pass through the incision to see and repair the varicocele.

PERCUTANEOUS EMBOLIZATION

This procedure is conducted during local anaesthesia on an outpatient basis. A tube is inserted into a vein in your groin or neck so that instruments can be passed. Your doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins while viewing your enlarged veins on a monitor. This blockage will interrupt the blood flow and repairs the varicocele.

DIAGNOSTIC SERVICES

  • History taking and physical examination: A physical exam will be conducted. This may reveal a nontender mass above your testicle that feels like a bag of worms. Your doctor will be able to feel it if it’s large enough. Your doctor may ask you to stand, take a deep breath and hold it while you bear down (Valsalva maneuver) if you have a smaller varicocele. This will help your doctor detect abnormal enlargement of the veins.
  • Scrotal ultrasound: High-frequency sound waves are used to create precise images of structures inside your body. This may be used to ensure that there isn’t another reason for your symptoms. Further imaging may be recommended to rule out other causes for the varicocele in some cases such as a tumor compressing the spermatic vein.

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