| Treatments >> Microsurgical Varicocelectomy
What is a Varicocele?
Varicocele is a term used to describe abnormally dilated veins of the testis located in the scrotum. The term varicosity is familiar to those who have seen varicose veins of the leg. Veins are vascular structures that carry blood away from an organ and arteries are the vessels which supply oxygen rich blood to organs. Veins normally have one-way valves present with in their lumen to prevent back flow of blood. When these valves are incompetent, blood can pool, as what happens with varicose veins of the legs upon standing. A varicocele is the same phenomenom in the scrotum, and these varicose veins can often be seen with the naked eye and look like “a bag of worms.” More commonly, however, a varicocele is only detected upon examination by a physician.
The exact cause of varicoceles and the method by which they damage the testis is unknown. The most popular theories is that varicoceles are caused by absent or abnormal valves in the veins of the scrotum. Since the reduced drainage of blood from the scrotum can affect the temperature of the testis, the tesis may be adversely affected from both a sperm production standpoint as well as testosterone production.
How Does a Man Present with a Varicocele?
There are three clinical scenarios related to varicoceles:
What kind of pain does a varicocele sometimes cause?
Varicocele is a potential cause of scrotal pain that is either dull like in quality or extreme. The typical varicocele is asymptomatic, however occasional patients note an aching feeling in the scrotum associated with prolonged standing or activity and the aching pain is relieved by lying down supine (on one’s back) with the feet raised.
Varicoceles may cause more severe pain if the veins develop thrombophlebitis. The evaluation of patients with scrotal pain should include scrotal ultrasonography to rule out other pathology and cultures to rule out infection. Repair of the varicocele may be considered when there is no other identifiable cause of the pain and the pain qualities are consistent with a varicocele, however there can be no guarantee that varicocele repair will eradicate the pain.
When Should a Varicocele Be Repaired?
Management of the young man with an incidental finding of an asymptomatic varicocele is somewhat controversial. There is strong evidence to suggest that repairing a varicocele improves testicular function and may prevent any further testicular damage over time. Thus, the first step in the evaluation of this patient is to assess testicular function directly by semen analysis or indirectly by measuring testis volume. Repair of the varicocele is indicated if there is any evidence of testicular damage.
Varicoceles are found on physical examination of roughly one third of men being evaluated for failure to conceive. They are categorized by size (large, medium and small) and by their presence on one or both sides of the scrotum. It is important to know that varicoceles of all sizes may affect fertility and the chance of improvement is equivalent after repair. In addition, a varicocele on side of the scrotum has an effect upon both testes in regards to function and temperature. Varicoceles that cannot be felt by the physician but are diagnosed by imaging studies, such as ultrasonography, are not clinically significant.
Varicocele repair can be performed surgically or non-surgically. There is no ideal method or absolutes in making this decision. The non-surgical repair is a minimally invasive technique performed by an interventional radiologist on an outpatient basis. The success rate varies significantly dependent upon the experience of the radiologist, the anatomy of the patient and the presence of varicoceles on both sides.
How Does Repairing a Varicocele Positively Affect Fertility?
Cayan S, Turek PJ. J Urol. 2002 Apr;167(4):1749-52
This means that repairing a clinically significant varicocele can significantly improve semen parameters and allow for natural conception or lessen the need of reproductive assistance. In addition, microsurgical varicocele repair can result in an improvement in testosterone production.