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About Varicocele
Varicocele is similar to varicose veins, but occurs in the loose bag, called the scrotum (the bag right below the penis), containing the testicles in men. The veins of the scrotum look swollen and may have slight pain or discomfort.
Surprisingly, this is a common occurrence among adolescent and young men aged between 15-25 and could be harmless. However, even adults who have fathered a child may suffer from varicoceles.
What is a Varicocele?
A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum). These veins transport oxygen-depleted blood from the testicles. A varicocele occurs when blood pools in the veins rather than circulating efficiently out of the scrotum.
Varicoceles usually form during puberty and develop over time. They may cause some discomfort or pain, but they often result in no symptoms or complications.
How does it form?
Varicoceles are caused due to vein abnormalities in the scrotum. The valves within the veins regulate blood flow to and from the testicels. Due to the abnormalities caused by a defective valve in the vein, blood circulation becomes irregular, causing the blood to pool. This results in an enlargement or inflammation of the veins in the scrotum.
This condition most commonly takes place during puberty, when the testicles are experiencing rapid growth. In about 85% of the cases, varicoceles are found on the left side of the scrotum. In rare cases, it can also exist on both sides of the scrotum.
Types of Varicoceles:
Stop-type varicoceles
Shunt-type varicoceles
Causes
Symptoms
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Blockage in the spermatic cord
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Injury around the scrotum or testicles
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Infections like epididymitis
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Drinking water while standing
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Exercising without any protective gear
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Puberty
If you notice any of these varicocele symptoms, do not wait longer and get immediate medical attention.
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Sharp pain in the scrotum, which gradually worsens throughout the day
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Pain worsens on physical exertion
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Twisted and large swollen veins on the scrotal sac
DIAGNOSIS
How is Varicocele detected and treated?
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Your doctor would perform a physical examination to check for varicocele. This may also be performed by a urologist, following which an ultrasound may be requested. If you are found to have a varicocele that is painful and requires treatment, yourdoctor would suggest surgery (varicocelectomy).
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Physical examination
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You would be asked to stand up and take a deep breath while your doctor prodes your scrotum (the loose bag just below your penis). This is medically called as a Valsalva procedure, and your doctor may perform this to check for lumps and testicularshrinkage (atrophy).
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Ultrasound
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An ultrasound may be requested to understand more about your condition and confirm the seriousness of the varicocele.
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There are three varicocele grades:
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Grade 1
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This is the smallest one that is not visible. However, if the physician uses a Valsalva maneuver, they can feel it.
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Grade 2
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This varicocele grade is not visible but can be felt without using a Valsalva maneuver.
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Grade 3
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The physician can see the varicocele.
How to prevent it?
The fact is, there is no way to prevent a varicocele. However, you might be able to restrict the condition from getting worse by taking certain measures that include- maintaining good health, following a healthy diet, drinking enough water and avoiding smoking. In order to make sure that your condition does not escalate any further, you should also avoid wearing tight fitted clothes. Improving and maintaining the health of your veins can help you deal with the pain and discomfort.
VARICOCELE SPECIALISTS DOCTORS
Dr. ABCD
MBBS,
10 yrs of experience
Dr. ABCD
MBBS,
10 yrs of experience
Dr. ABCD
MBBS,
10 yrs of experience
Types of Surgery
Types of surgery/operation for varicocele
In India, most of the surgeries done are laparoscopic varicocelectomies, which are completely safe. However, your doctor may suggest an open surgery, percutaneous embolization or a microscopic varicocelectomy, depending on your condition.
Surgeries for men with varicoceles have shown to moderately increase their fertility, and are hence considered the right treatment option for those with painful varicoceles.
Open Surgery
In this type, the veins that are engorged would be closed and the blood would be diverted through healthier veins.
Laparoscopic surgery
An incision is made on the external surface of the abdomen through which a camera (called laparoscope) and surgical instruments are sent through a thin tube. The unhealthy veins are ligated to ensure a healthier blood flow.
Percutaneous Embolization
This method involves the release of a fluid or coil that will scar, plug or seal the affected veins to ensure healthy blood flow. Percutaneous embolization is an uncommon procedure, which is sometimes performed along with a radiologist.
Laparoscopic Varicocelectomy: This process is mostly preferred in treating patients diagnosed with second or third grade of varicoceles and is performed using general anesthesia. During the procedure, the surgeon makes small incisions in the abdomen. Through one of the incisions, the surgeon inserts a thin lighted scope (laparoscope) and inflates the abdomen using CO2 gas, which enables them to have a clear view of the internal organs. Once the swollen veins are identified, they are cut and the ends are closed off. As soon as the ends are sealed, all the tools are removed and the incisions are closed with sutures or clips and dressing is applied.
Microscopic varicocelectomy: This procedure is generally performed if there is a risk of infertility. In this process, the surgeon makes a tiny incision above the scrotum. With the help of a microscope, the surgeon separates the testicular arteries and vas deferens in the scrotum. Keeping the lymphatic drainage intact, the surgeon then dissects down to the spermatic cord. After the abnormal veins are encountered, each vein is meticulously dissected circumferentially and tied off to disrupt the flow, before draining the blood away from the testicle into the inner thigh and pelvis.
SEVERITY OF THE DISEASE:
Grade II
(The varicocele is not visible.)
Grade II
(The varicocele can be felt at rest)
Grade III
(The varicocele becomes clearly visible.)