Varicocele

What is Varicocele?

Varicocele is the dilatation (enlargement) and tortuosity of testicular veins due to venous insufficiency, as it happens with varicose veins in the legs. It usually occurs in the left testis due to purely anatomical reasons.

Veins normally allow the blood flow from the periphery of the body to its center, and from the smaller veins to the larger ones. This reverse motion of  blood is achieved thanks to special valves of the veins that prevent blood from moving backwards. When valves are insufficient, there is backflow of the blood from the larger veins to the smaller ones and from there to the testes. This condition induces varicose enlargement of  spermatic veins and the phenomenon of  Venous Blood Regurgitation within the testis -with venous blood having no nutritional value. As a result, venous blood pools within the testis and does not allow sufficient  amount of arterial blood to enter.

What could Varicocele cause?

In some patients, varicocele might:

  • induce mild pain or sensation of scrotal heaviness/discomfort 
  • prevent normal growth of the suffering testis
  • affect semen quality and therefore fertility

How is varicocele diagnosed?

Varicocele is usually discovered by accident by the patient or the physician during a routine physical examination. On palpation, the testis feels like a soft mass with ill-defined borders. It is characteristic that this mass becomes smaller when the patient is in lying position but larger when the patient is in the standing position and when intraabodminal pressure increases (tightenining the abdomen during physical exercise, weight elevation, sports).This happens because veins evacuate in the supine position, whereas they fill up abruptly in the standing position. The diagnosis is confirmed with ultrasound screening (colour Triplex). The following varicocele classification is useful in clinical practice:

  • Subclinical: Not visible, either at rest or with high intraabdominal pressure; diagnosed with ultrasound screening
  • Grade I: Palpable with high intraabdominal pressure but not at rest
  • Grade 2: Palpable at rest, but not visible
  • Grade 3: Visible at rest

Is there any effect of Varicocele on Infertility?

Varicocele occurs in about 11,7% of the general adult male population and in 25,4% of  male infertility cases. The correlation between male infertility and varicocele is unknown, but it is clear that the sperm improves after surgical treatment as long as this takes place on time. Also, it seems that varicocele causes impairment to the sperm DNA, which subsides after the varicocele treatment.

I have varicocele. Should I have it treated?

In some patients, varicocele causes progressive testicular impairment, which is connected with infertility. Surgical restoration may be effective in these cases. Varicocele should definitely be treated in:

  • Children, when ultrasound findings show retarded testicular growth 
  • Men with affected sperm (If they have clinical varicocele and face infertility problem for at least 1 year, it is highly likely that infertility is due to the varicocele)

      - Subclinical varicocele should not be surgically operated.

How is Varicocele treated?

Varicocele is treated surgically (Varicocelectomy), by interrupting the circulation of spermatic veins. The incision done is very small next to the penis; abdominal muscles are not opened and the patient is discharged from hospital the very next postoperative day and resumes to his/her daily activities within 3 days. In some centers, there are also other techniques applied; however, these do not give any better results and are more expensive (e.g. laparoscopy). In any case, the type of surgical procedure depends mainly on the surgeon's experience.

Alternatively to surgery, there is the option of spermatic vein embolization; yet, this may have more complications and therefore is not widely used.