Varicocele is a mass of enlarged veins that develops in the spermatic cord, which leads from the testicles (testes) up through a passageway in the lower abdominal wall to the circulatory system. The spermatic cord is made up of blood vessels, lymphatic vessels, nerves, and the duct that carries sperm from the body (vas deferens). If the valves that regulate bloodflow from these veins become defective, blood does not circulate out of the testicles efficiently, which causes swelling in the veins above and behind the testicles.
A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle. The left spermatic vein drains into the renal vein between the superior mesenteric artery and the aorta; these two arteries can compress the renal vein and thus impede bloodflow from the spermatic vein. The right spermatic vein drains into the vein that returns blood to the heart (vena cava) and develops varicocele less often. A one-sided (unilateral) varicocele can affect either testicle.
Because of the impaired circulation of blood created by a varicocele, the blood does not cool as it does normally. The increased temperature of the blood raises the temperature of the testes, which is believed to contribute to infertility, as heat can damage or destroy sperm. The increased temperature may also impede production of new, healthy sperm.
Incidence and Prevalence:
Incidence of varicocele is 10-20% and is highest in men between the ages of 15 and 25. The sudden appearance of varicocele in an older man may indicate a renal tumor blocking the spermatic vein.
Approximately 40% of infertile men have a varicocele and among men with secondary infertility-those who have fathered a child but are no longer able to do so-prevalence may be as high as 80%.
What are the Symptoms and Signs of Varicoceles?
The patient may be aware of a lump, especially when standing, but may notice that the swelling usually disappears when lying down. The degree of discomfort or pain varies considerably from one person to another. There may not be any discomfort; however, some men may experience an uncomfortable dragging pain, especially in hot weather or after exercise. The lump, which may have a bluish appearance through the skin, is soft to feel, like a bunch of grapes or a bag of worms. Tests are not usually necessary, but an ultrasound may be ordered if there is any doubt about the diagnosis.
Who Can Get a Varicocele?
A varicocele is generally first noticed in males between puberty and 35 years of age, especially near the end of adolescence. Any male can be affected, although it is seen more frequently in tall, thin men, especially those from hot climates. Varicoceles are common and found in about 8% of the adult male population.
What is the Cause of Varicoceles?
The cause is a mechanical problem in the drainage of the testicular vein into the renal vein of the kidney. A faulty valve in the testicular vein leads to back pressure in the system and thus swollen varicose veins around the testicle. There is not a known reason why only certain men experience the condition; however, there is a tendency for varicoceles to run in families.
What is the Risk of Varicoceles?
A primary varicocele is a relatively minor condition without serious consequences. However, in some men the discomfort is such that surgical treatment is required while others can live with a very mild discomfort. Varicoceles are thought to be associated with decreased fertility, although this has not been scientifically proven.
What is the Treatment for Varicoceles?
If the varicocele is not causing the patient discomfort, treatment is not necessary. For mild discomfort and swelling, the patient can wear firm-fitting underpants or a jockstrap. (Keep in mind that the discomfort and swelling tends to disappear when lying down.)
Is Surgery Needed for Varicoceles?
Surgery may be recommended if the varicocele is causing significant discomfort, or associated with a reduced size of the left testicle or infertility. The operation is a straightforward but delicate procedure in which the vein draining the varicose veins is ligated, or tied off. This causes the veins to collapse without affecting the testicle’s function. Results from surgery are very good, with an 80% success rate & pregnancy rates of 45% to 50%.