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 vein” that can be seen in the legs, that is, varicose veins.

Cases occur in the upper part of the testicles, usually in the left testis. Individuals may not be able to see the varicocele while lying down, but it may become prominent enough to see the eyes 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 that usually affects young men. This issue affects 10 to 15% of men. If varicocele is present,itself does not cause a medical problem, 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 in amounts that can cause infertility. However, sperm production is not affected in all cases of varicocele. Varicocele can cause infertility as well as the testicles not developing normally or shrinking.

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 can only be treated if it causes symptoms, and the method used is usually surgery.


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 the proper blood flow, the blood collects back and causes the veins to dilate.

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

Varicocele usually occurs in boys during puberty. Under normal conditions, it is observed that the left testis is located on the left testicular vein because it is lower than the right testis.

While 90 percent of varicocele cases are seen in the left testicular vein, 9 percent in both testicles, that is, bilaterally, 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 in its own form. Rarely, it can cause pain. Varicocele pain may 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 can relax when they lie on their backs. 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, develop a varicocele in their youth, or have difficulty conceiving a child should see a doctor immediately.There are many medical conditions that cause scrotal masses or testicular pain, some of which require immediate treatment.

What are the Complications of Varicocele?

Apart from pain, there are two general complications that varicocele can cause:

  • 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 by the varicocele condition, 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 and sperm movement, that is, motility, and preventing them from performing their functions.

Diagnostic Methods

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 the breath out by straining.

This is called the Valsalva maneuver, and it helps you feel more enlarged veins than normal.

With the help of the Valsalva maneuver, varicocele is evaluated to three different degrees during the examination.

  • Grade 1: Varicocele in which no symptoms can be observed in the outpatient patient but can be palpated during the Valsalva maneuver.
  • Grade 2: Varicocele, which is mildly observable in an outpatient patient and in which the veins become clearly visible as a result of the Valsalva maneuver.
  • Grade 3: Varicocele with clearly visible veins, although the outpatient patient has not started the 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 tumor that may be causing the symptoms. It is especially helpful in determining how treatment should take place for young people.

Treatment Methods

How is Varicocele Treatment Performed?

Varicocele treatment may not be necessary for every individual. Many men with varicocele can become fathers without any treatment. Although treatment for varicocele usually results in an improvement in 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 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, namely hydrocele,
  • Recurrence of varicoceles
  • Infection,
  • It counts as vein damage.

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

  • Varicocelectomy, that is, varicocele surgery, 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 on a single day 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, that is, from the inguinal way, or from the subinguinal way, 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 occur around 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 or destruction 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 among those who have varicocele surgery.

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 during varicocele surgery. 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 with non-compulsive activities after two days and can start strenuous work such as exercising within two weeks unless there is a separate discomfort.

Although varicocele surgery pain is mild, it can last for a few days or weeks. The doctor may prescribe pain medication for the patient to use for a limited period of time after surgery. But he will recommend over-the-counter pain relievers for future ailments.

After the surgery, the doctor may recommend not having 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 (i.e., infertile men suffering from varicocele) undergoing the procedure recover after this surgical intervention. Surgical intervention also gives successful results for most young people who have slowed testicular growth.

How does the pain of varicocele pass?

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:

  • Use over-the-counter pain relievers recommended by your doctor or available from pharmacies.
  • Wearing tight underwear or tank tops 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 benefit indirectly 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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