Varicocele
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Varicocele

Varicocele

A varicocele is an enlargement of the veins within the testicle and scrotum that may cause pain and lead to shrinkage of the testicles.  In healthy veins within the scrotum, one-way valves allow blood to flow from the testicles and scrotum back to the heart.  In a varicocele, these valves do not function properly, causing blood to pool enlarging the vein.  It is believed that the raised temperature that results from the pooled blood in these blocked veins can decrease sperm count and motility of sperm and increase the number of deformed sperm which in some cases can lead to infertility.   The scrotum is a skin-covered sac that holds your testicles. It also contains the arteries and veins that deliver blood to the reproductive glands. A vein abnormality in the scrotum may result in a varicocele.

Prevalence

  • Approximately 10 percent of all men have varicoceles.
  • Among infertile couples, about 30 percent of men have varicoceles.

Symptoms

Pain: Men who experience pain in their testicles particularly when exercising, standing or sitting for a long period of time may be have varicoceles. Typically, painful varicoceles are prominent in size. If left untreated, varicoceles may lead to infertility.
Fertility problems: There is an association between varicoceles and infertility. Decreased sperm count, decreased motility of sperm and an increase in the number of deformed sperm are related to varicoceles.  It is believed these blocked and enlarged veins around the testes cause infertility by raising the temperature in the scrotum and decreasing sperm production.
Testicular atrophy: The shrinking of the testicles is another sign of varicoceles. Often, once the testicle is repaired, it will return to normal size.

Varicocele Diagnosis

Varicoceles are fairly simple to detect and diagnose through physical or diagnostic examination. Varicocele repair is done to improve male fertility. It can usually be done surgically on an outpatient basis using local or general anesthetic. A small incision is made in the abdomen close to where the testicles originally descended through the abdominal wall. The veins that produce the varicocele are identified and cut to eliminate blood flow to the varicocele.

Alternatively, there is a nonsurgical procedure called percutaneous embolization can be done to repair a varicocele. A small catheter is inserted through a large vein in the groin or neck and advanced to the varicocele, which is then blocked off by a balloon, coil, or medicine.

After Surgery

Varicocele repair typically is done on an outpatient basis. You can expect to go home within 4 hours of a routine varicocele surgery. Pain medicine is prescribed for a few days after surgery. You should be able to resume light work duties 1 to 2 days after surgery and full strenuous activities within one week.

Why the Surgery is done

Varicoceles are thought to raise the temperature of the testicles or cause blood to back up in the veins supplying the testicles. Although the mechanism by which varicoceles affect fertility is poorly understood, varicoceles might damage or kill the sperm. Varicocele repair is typically done to improve the fertility of men who have both a varicocele and impaired sperm. At our centre we recommend our patients to consult with our Urologist.  While some researchers have observed that varicocele repair produces favorable pregnancy rates, others have noted that these pregnancy rates are the same as the rates of couples who have chosen not to have a varicocele repaired.  There is no proof that fertility rates improve after this surgery. But some doctors think that larger varicoceles are linked to sperm problems. It is also possible that varicocele surgery would improve the semen quality, making other fertility treatments easier. Small varicoceles that are only apparent with ultrasound testing do not require repair.  Again, varicocele surgery may even decrease sperm count after the surgery.

Risks

  • Infection at the site of surgery
  • Fluid buildup in the scrotum that requires draining
  • Injury to the arteries or nerves in the pubic area
  • Sperm count reduction

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