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Varicocele

TREATMENTS

What is varicocele?

A varicocele is A condition where there is an abnormal enlargement and tortuosity of veins of the testes and scrotum that may cause pain and result in shrinkage of the testicles. These blocked veins can lessen the sperm count and motility of sperm and can increase the number of malformed sperms causing difficulty in having children.

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Varicocele1

How common is it ?

  • About 10 percent of all men have varicoceles.
  • Among infertile couples, 30 percent of men have varicoceles.
  • The highest occurrence of varicoceles is in men ages 15–35.
  • 80,000–100,000 men may undergo surgical correction of varicoceles each year.

Symptoms

A varicocele often produces no signs or symptoms. Rarely, it might cause pain. The pain may:

  • Vary from sharp to dull discomfort
  • Increase with standing or physical exertion, especially over long periods
  • Worsen over the course of a day
  • Be relieved when you lie on your back
  • Impaired fertility

Varicocele Diagnosis :

Varicoceles are easy to catch and diagnose through physical examination which might reveal a nontender mass above your testicle that feels like a bag of worms. If it’s large enough, for your doctor will be able to feel it.

If you have a smaller varicocele, your doctor might ask you to stand, take a deep breath and hold it while you bear down (Valsalva maneuver). This helps your doctor detect abnormal enlargement of the veins.

 

If the physical exam is inconclusive, your doctor might order a scrotal ultrasound colour Doppler.

Varicoceles are easy to catch and diagnose through physical examination or diagnostic examination

  • Of the 95 percent of varicoceles that are found, they are located on the left side of the scrotum.
  • The scrotum looks like a bag of worms.
  • The testicles may be shrunken in size.
  • On the off chance that varicoceles are not detectable through the above criteria, unusual blood flow can regularly be detected with a noninvasive imaging exam called color flow ultrasound or through a venogram—a radiograph in which a special dye is injected into the veins to “highlight” abnormalities of the blood vessels.

Varicocele : Treatment Options

Varicocele treatment might not be necessary. However, if your varicocele causes pain, testicular atrophy or infertility you might want to undergo varicocele repair

Catheter-directed varicocele embolization:

Catheter-directed varicocele embolization is a nonsurgical procedure done by an interventional radiologist, which is highly effective and a widely available procedure to treat varicoceles symptoms. An Interventional radiologist inserts a tube (catheter) into a vein in your groin through which wires and coils can be passed. Viewing your enlarged veins on a monitor, the interventional radiologist releases coils or a sclerosant solution that causes scarring to create a blockage in the affected testicular veins, which interrupts the blood flow and reduces the pressure in the varicocele as the blood is directed to other pathways. Thus the varicocele shrinks in size. 
After embolization, you can often return to work after two days, and begin exercising after seven to 10 days.

Surgical ligation:

One of the most common varicocele treatments is open surgical litigation. During open surgical litigation, typically performed by a urologist, a cut is made in the skin above the scrotum down to the testicular veins. The veins are then tied off with sutures. 24 percent of surgical litigation patients are required to stay overnight in the hospital while most patients are able to leave the hospital the same day. After open surgical ligation, patients can expect a two to three week recuperation period

Advantages of Catheter-directed Embolization

  • Cost effective
  • No surgical incision in scrotal area
  • No general anesthesia required
  • No sutures
  • No infections
  • As effective as surgery, as measured by improvement in semen analysis and pregnancy rates
  • Patients can return to normal daily activities immediately and without hospital admittance; surgery requires several weeks’ recovery and hospital admittance
  • The rare patient who has varicoceles on both sides can have them fixed simultaneously through one vein puncture site; surgery on both sides requires two separate open incisions