<Varicocele>

Cause

Varicocele is the abnormal dilatation of the pampiniform venous plexus in the scrotum. It is caused by the venous valvular failure, venous valvular incompetence and venous hypertension of the pampiniform venous plexus. Venous blood stasis affects the normal venous blood returning to the heart, it is worsened after prolonged standing or sitting. The distended veins of the testicles and spermatic cords affects the capillary blood flow to the testes. As there is poor capillary blood flow to testes and the scrotal temperature rises with the venous blood stasis, these affect testosterone production and sperm formation. Varicocele may cause premature death of sperm and male infertility. Rarely, intra-abdominal tumors compressing the proximal veins can cause varicocele.

Symptoms

Varicocele usually occurs in the left side of the scrotum in most patients. Bilateral varicoceles can occur in the same patient simultaneously or one side first and the other side later. Patients with varicocele are usually visible from a distance and often being described as "a bag of worm ". After prolonged standing or prolonged sitting (unchanged posture), patients with varicocele may feel dragging pain or heaviness in the scrotum. The dilated varicocele is compressible and is more obvious by increasing the intra-abdominal pressure (e.g. Valsalva Maneuver or weight lifting). The varicocele may disappear when lying down and elevating the scrotum.

Clinical Diagnosis

Experienced doctors can make the diagnosis of varicocele after history taking and physical examination. Color doppler ultrasound scan can confirm the diagnosis.

Treatment

Varicocele is nearly always due to valvular incompetence of the diseased veins. The surgical treatment is called varicocelectomy. Varicocelectomy involves protecting the vas, preserving the normal arterial and venous blood flow of the testis, and ligation and excision of the diseased veins of varicocele. There are many methods to perform varicocelectomy. Magnifying glasses, microscopes, or laparoscopic magnifying monitors are often used during varicocelectomy.

Varicocelectomy is usually done under general anesthesia or (lower half body) spinal anesthesia. Traditional open inguinal or subinguinal varicocelectomy surgery requires an incision at the groin or lower abdomen. Laparoscopic varicocelectomy requires making three keyhole incisions in the abdomen. New mini-incision high scrotal varicocelectomy requires a 2cm high scrotal small incision wound to gain access to the diseased veins of varicocele and completes the procedure. The surgery time is usually less than 1 hour. The post-operative wound pain is low as long-acting local anesthetic is injected into the wound. The wound is well protected by glue and water-repellent dressing. Patients return to work a few days after surgery. Please consult your doctor for advice.

Varicocele is primarily due to reflux of the pampiniform venous plexus or, to a lesser extent, due to venous reflux in the scrotal skin. The theory of varicocele surgery is to prevent the reverse flow of venous blood by ligating and removing abnormally dilated veins. Varicocele resection improves venous and microvascular blood flow to the testicles.

Varicocelectomy studies have shown significant improvements in one or more sperm parameters of the semen analysis report in more than 65% of treated men. About 70% of men with varicoceles improved their testosterone levels after varicocelectomy. About 80% of men had scrotal pain improvement after varicocelectomy. Please consult your doctor for advice.

FAQs

Q. How can I relieve the pain of varicocele?

A. If you have a varicocele that causes minor discomfort, and it does not affect your fertility, you might try the following for pain relief:

  • Support the scrotum by wearing an athletic supporter or snug-fitting underwear.
  • Take pain medicine, such as acetaminophen/paracetamol, ibuprofen, or other NSAIDs.

Surgery (Varicocelectomy) is a permanent solution to relieve the pain of varicocele. Please ask your doctor for advice.

Q. What happens if I have varicocele and I refuse treatment?
A. Varicoceles can cause three problems: Impaired fertility, decreased testosterone production from the testes, or scrotal discomfort. If you want to improve either one of these problems, you may need to consider surgery, i.e. varicocelectomy. Otherwise, you will suffer the consequences of varicocele. Varicocelectomy is a very safe surgery. You just need a few days of sick leave. The post operative pain is minimal. Please consult your doctor for advice.
Q. Is varicocelectomy a safe surgery?
A. Varicocelectomy is a very safe surgery. The postoperative complication rate is less than a few percent. Please consult your doctor for advice.