What Is a Varicocele?
Varicoceles are a relatively common condition (affecting approximately 10 percent of men) that tends to occur in young men, usually during the second or third decade of life. Sometimes, these varicoceles cause no symptoms and are harmless. But sometimes a varicocele causes pain or fertility problems.
Normally, blood flows to the testicles through an artery, and flows out via a network of tiny veins that drain into a long vein that goes up through the abdomen. The direction of blood flow in this vein should always be up, toward the heart. A series of one-way valves in the vein prevent the reverse flow of blood back to the testicles.
These one-way valves sometimes fail. The reverse flow of blood stretches and enlarges the tiny veins around the testicle to cause a varicocele.the veins that gives them a bulging appearance. This process most commonly occurs in the greater saphenous vein in the leg.
Varicocele Symptom
Typical varicocele symptoms are mild and many do not require treatment. Treatment may be necessary if the varicocele is causing discomfort or any of the other problems listed below
Pain
One of the signs of varicoceles is an aching pain when the individual has been standing or sitting for an extended time and pressure builds up in the affected veins. Heavy lifting may make varicocele symptoms worse and, in some cases, can even cause varicoceles to form.
Fertility Problems
There is an association between varicoceles and infertility or subfertility, but it is difficult to be certain if a varicocele is the cause of fertility problems in any one case. In one study, as many as 40 percent of men who were subfertile were found to have a varicocele. Other signs of varicoceles can be a decreased sperm count; decreased motility, or movement, of sperm; and an increase in the number of deformed sperm. It is not known for sure how varicoceles contribute to these problems, but a common theory is that the condition raises the temperature of the testicles and affects sperm production. Studies have shown that from 50 percent to 70 percent of men with fertility problems will have a significant improvement in the quality and/or quantity of sperm production after they have undergone varicocele repair.
Treatment Options
Varicocele Surgery
Varicocele Surgery is usually performed under general anesthesia in an outpatient setting. In this type of varicocele treatment, the surgeon makes an incision above the scrotum and cuts through the layers of tissue to expose the veins.
The affected veins are ligated, or tied off, to detour the flow of blood into normal veins. Recovery time depends on the type of surgery, but most patients require up to six weeks before heavy lifting and other strenuous activities can be performed. Light activities may be resumed more quickly.
Varicocele Embolization
In this type of varicocele treatment, a small tube is inserted into the groin through a small nick in the skin. The skin is numbed for this procedure and it is not painful. Next, a small catheter, or tube, is painlessly guided up into the abdomen and into the varicocele vein under the guidance of x-ray imaging. Tiny metal coils are deployed through the catheter to block the flow of blood within the varicocele. The tube is removed and patients are on bed rest for three hours. Patients go home the same day and can resume normal activities within 48 hours.
Advantages of Varicocele Embolization
- It is as effective as surgery, as measured by improvement in pain, semen analysis and pregnancy rates.
- It does not require any surgical incision in the scrotal area.
- A patient with varicoceles on both sides can have both fixed at the same time through one vein puncture site (surgery requires two separate open incisions)
- There is a lower rate of complications compared to surgery. Infection has not been reported after embolization.
- It requires less recovery time. Patients may return to normal activities within 48 hours.
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