Varicocele: Causes, Symptoms, Treatment, Complications, and Prevention, Estimation Cost
OverView Varicocele –A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum).
A varicocele is similar to a varicose vein that you can see in your leg.
Varicoceles are a common cause of low sperm production and decreased sperm quality, which can lead to infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause the testicles to not develop normally or to shrink.
Most Varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose, and many do not need treatment. If a varicocele causes symptoms, it can often be repaired surgically.
SymptomsA varicocele often has no signs or symptoms. In rare cases, it can cause pain. Pain can:
- Varies from acute to deaf discomfort
- Increases with physical exertion or standing, especially for prolonged periods
- It gets worse over the course of a day
- Be relieved when you lie on your back
- Impaired fertility
- Over time, varicoceles can get larger and more noticeable. A varicocele has been described as looking like a “bag of worms.” The condition can cause a swollen testicle, most often on the left side.
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When to See a DoctorBecause a varicocele usually doesn’t cause symptoms, it often doesn’t require treatment. Varicoceles can be discovered during a fertility evaluation or routine physical exam.
However, if you experience pain or swelling in the scrotum, discover a mass in the scrotum, notice that your testicles are different sizes, develop a varicocele in your youth, or have fertility problems, contact your doctor. Several conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.
CausesMale reproductive system
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Your spermatic cord carries blood to and from your testicles. It is not known for sure what causes varicoceles.
However, many experts believe that a varicocele forms when valves within the veins of the cord prevent blood from flowing properly. The resulting backing causes the veins to widen (dilate). This could damage the testicle and worsen fertility.
Varicoceles often form during puberty. Varicoceles usually appear on the left side, probably due to the position of the left testicular vein.
There does not appear to be any significant risk factor for developing a varicocele.
A varicocele can cause:
Contraction of the affected testicle (atrophy). Most of the testicle comprises sperm-producing tubules. When damaged, like a varicocele, the testicle shrinks and becomes soft. It is not clear what causes the testicle to shrink, but malfunctioning valves allow blood to pool in the veins, which can lead to increased pressure in the veins and exposure to toxins in the blood that can cause testicular damage.
Sterility. Varicoceles can keep the local temperature in or around the testicle too high, affecting the formation, movement (motility), and function of sperm.
What will happen if I decide not to receive treatment?
Most men with a varicocele will have no problems. One in five men with a varicocele will experience difficulty having children. Semen analysis is strongly recommended after age 16 to determine if varicocele repair is necessary. If a semen analysis is normal, it is recommended to repeat the analysis every 2 to 3 years, as over time the quality of the sperm may decrease. Fertility problems can emerge years later, even if they haven’t been seen before.
My teenage son was diagnosed with a varicocele. Should this be fixed?
Treatment of adolescents depends on each case. Discussing your options with a urologist or pediatric urologist is invaluable. Varicocele repair in an adolescent may be a good option if there is pain, if one testicle is much smaller than the other, or if the adolescent has an abnormal semen analysis done at age 16. Some choose repair so they don’t have to worry about future fertility problems. Semen tests can be done on older teens to see if the repair helps.
I have no symptoms, but I want to have children. Should I repair my varicocele?
As a general rule, varicoceles without symptoms are not repaired. Most health care providers do not believe that these varicoceles cause health problems if they are not treated. If you are concerned about fertility, a semen analysis may be done to see if the varicocele is damaging sperm quality.
I have pain with my varicocele. What can I do to ease the pain?
Supporting the scrotum with a jockstrap or underwear can help with varicocele pain. Lying on your back helps the varicocele drain and often relieves pain. Taking pain relievers (such as acetaminophen and ibuprofen) can also help. You can also talk to your urologist about varicocele repair.
I am thinking of having my varicocele repaired for fertility reasons. How long will I have to wait to see if the quality of my semen improves?
Semen analyzes are often done three to four months after the procedure. Semen quality usually improves within six months, but it can also take up to a year.
I found a lump in my scrotum during a self-exam. Should I be worry?
Anomalies in the male reproductive system can appear as a mass in the scrotum. Masses may not be a cause for concern and may have little effect on your health. Or they could be a sign of a life-threatening illness. Finding out what is causing your mass is of great value. One type of mass can be testicular cancer. This would be cause for concern and requires prompt action. It is vital to see a doctor when you find any lumps or bumps on your testicle.
Treatment of Varicocele Without Surgery by Embolization
Varicocele is a relatively common condition that affects approximately 10 percent of men during the second or third decade of life. Sometimes, sometimes they cause pain or atrophy or fertility problems. Normally, blood flows to the testicles through an artery and out through a network of tiny veins that drain into a long vein that runs up the abdomen. A series of one-way valves in the vein prevent the reverse flow of blood to the testicles.
1. Pain is painful ache when the person has been standing or sitting for a long time and pressure builds up in the affected veins. Lifting heavy objects can make varicocele symptoms worse, and in some cases, it can even lead to varicocele formation.
2. Fertility problems: varicocele raises the temperature of the testicles and affects sperm production. Studies have shown that between 50 and 70 percent of men with fertility problems will have a significant improvement in the quality and / or quantity of sperm production after undergoing varicocele embolization.
3. Testicular atrophy or shrinkage of the testicles is another of the signs of varicoceles.
Diagnosis: – Varicocele can be diagnosed during a physical exam. A large varicocele can make the scrotum look bulky and look like “a bag of worms.” When varicocele symptoms are not clearly present, abnormal blood flow can often be detected with a non-invasive imaging test called a color flow ultrasound.
Treatment of varicocele without surgery by embolization
Due to the lack of awareness about non-surgical treatment, patients frequently undergo surgical treatments that result in surgical scarring, prolonged hospitalization, chances of infections, surgical suturing, and performed under general anesthesia.
Non-surgical treatment is performed by an interventional radiologist and the benefits are painless, without surgical scar, patients can return to normal daily activities immediately. A patient with varicocele on both sides can fix them simultaneously in one session and it is also cost effective.
Varicocele embolization is a day care procedure performed under local anesthesia using “twilight” sedation. In this type of varicocele treatment, a small tube is inserted into the groin or neck through a small notch in the skin (about the size of a pencil lead). The skin is numbed for this procedure. The catheter is passed through and directed into the testicular vein. With the injection of contrast, the interventional radiologist determines exactly where the problem is, and through the use of coils, through embolization, the blood flow is redirected to other healthy pathways. The entire non-surgical treatment procedure is less painful and takes between 30 minutes to an hour. The tube is removed and no stitches are needed. Patients usually return to work the next day.
Embolization is effective in improving male infertility and costs about the same as surgical ligation. The study shows that sperm concentration improved in 83 percent of patients undergoing embolization compared to 63 percent of those surgically tied.
Pregnancy Hindrances – Men Infertility
Men may experience fertility problems because of a variety of abnormal physical conditions.
Sexually Transmitted Diseases: Blockage of the sperm ducts may be caused by STDs. STDs, such as chlamydia, have also been linked to low sperm count. Antibiotic treatment usually treats this condition.
Obstruction of the VASDEFERENS or EPIDIDIYMIS: Normally, the vas deferens and the epididymis transport sperm. An obstruction along these tracts will result in a sperm count of zero. Surgical treatment is usually required.
Varicocele: A varicocele is a collection of dilated veins within the scrotum that look like varicose veins. It lessens a man’s fertility by producing a slightly higher temperature in the testicles. A varicocele occurs in about 15 percent of all men and accounts for as much as 40 percent of male infertility problems.
Previous Vasectomy: A vasectomy is a voluntary surgery to block the sperm ducts for the purpose of contraception. Sometimes, for various personal reasons, the man wishes to have his vasectomy reversed. While it is usually possible to surgically reconnect the tubes after vasectomy, some men remain infertile because their body has developed an immune reaction against their own sperm. That means they develop antibodies that automatically destroy or immobilize their own sperm. This is more often the case when the vasectomy occurred more than 10 years earlier.
Diethylstilbestrol (DES) -Abnormalities of the male Reproductive Organs: Unfortunately, it is not just DES daughters who are affected; if the woman who took the DES was pregnant with a male child, her son may experience fertility difficulties as well. Sons of women who took this drug have been found to have abnormal sperm type and motility. They also occasionally have testicular abnormalities. If you suspect that your partner has been exposed to DES, please alert your fertility specialist.
Genetics – Inherited Fertility Problems: In rare cases, male infertility may be inherited. This is usually diagnosed through blood samples and by performing chromosomal analysis. For example, a man with cystic fibrosis may have missing or obstructed vas deferens, the tubes that carry sperm. Another example is where the man is born with two X and one Y chromosomes (the normal is one X and one Y). In this situation, the man has had abnormally developed testicles since puberty but possesses other normal male physical characteristics. A more common genetic disorder is polycystic kidney disease, a condition where large cysts form on the kidneys and other organs and may cause infertility if a cyst develops in the man’s reproductive tract.
Any of the above mentioned problem can be a cause of the infertility in men and proper solution to the problem can lead the men to make her partner conceive.