Varicocele is the tortuous enlargement of the veins in the scrotum above and around the testis. It is the most common cause of low sperm count and low motility of sperms leading to infertility. It may cause pain in the scrotum and may lead to shrinkage testicles.
What are the symptoms to watch out for?
Varicoceles rarely cause severe pain but when it does, the pain is :
- Usually dull aching
• Increase with high exertion or strenuous exercise or when standing for a long time
• Worsens with time
• Relieved on lying down
When Varicocele is large, it is felt and sometimes visible as “BAG OF WORMS” above the testicle.
It mostly occurs on the left side, but some time may be on both sides of the scrotum.
How is it caused?
Testes hang in the scrotum by their stalk called spermatic cord. It contains Arteries, veins, lymphatics, and nerves of testes. Arteries bring fresh blood with nutrients to testes and veins clear bad blood and excreta of testes. Blood travels in veins against the gravity toward the heart but valves in veins prevent backflow. When valves in veins got damaged, blood backflows and veins in scrotum swell up. Veins no longer able to clear bad blood and excreta of testicles. Hence, testicles do not get proper nutrition and temperature for the growth of sperms. Therefore, a patient develops low sperm count and weak sperms. Lack of proper nutrition causes mild pain and ultimately may lead to shrinkage of testicles.
How is the condition diagnosed?
Examination by Urologist in Ghaziabad in lying down and standing condition while the patient holds his breath and strain for stool reveal dilated veins.
Diagnosis can be confirmed by Doppler Ultrasound of Scrotum.
Treatment is necessary only when the varicocele causes the following-
- Pain
• Infertility
•Testicular Atrophy
Treatment options –
Treatment involves tying up of abnormal veins, so that blood flow normalizes. It can be achieved by following methods but Microscopic microsurgical method is best –
- Conventional Open Surgical Varicocelectomy – It is usually done by a cut in the abdomen. But this method is not accurate as lots of lymphatics are also tied which causes hydrocele. Some dilated veins may be left leading to recurrence or persistence of the problem.
- Laparoscopic Varicocelectomy –By making 3-4 holes in the abdomen main testicular vein is ligated. It is less painful but is associated with high recurrence rates due to patency of other veins of the scrotum.
- Angio-embolization- A small catheter is inserted into the abnormal veins through the groin area. The main testicular vein is blocked by sclerosant or coil. It is a convenient daycare procedure but is associated with high recurrence rates due to patency of other veins of the scrotum.
- Microscopic Microsurgical Varicocelectomy – It is done by small cut just above the scrotum. All the dilated veins are ligated by examining under a microscope and dissecting finely by the microsurgical method. All types of dilated veins are tied leaving lymphatics & arteries unhurt. This method gives almost 99% success and a minimum chance of recurrence or complication.