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What is varicocele?

Varicocele is the dilatation of the veins of the testicle and is a venous insufficiency (like in the legs). More often, it is observed in the left testicle, but it can also appear on the right or bilaterally.

What are the causes?

Varicocele occur in 11.7% of people and its cause lies in the fact that people stand on their two legs, overcoming gravity, burdening the veins that must return blood from the periphery to the heart. For this reason, there are valves along the entire route of the veins that do not allow the blood to move backwards. When these valves fail, blood backs up causing the veins to swell.

More often, varicocele is observed in the left testicle, due to anatomical difference of the left from the right spermatic vein. The left begins at the level of the left kidney (renal vein), while the right begins at the level of the umbilicus (inferior hernial vein), showing smaller resistances during blood flow.

What can varicocele cause?

Varicocele can be felt as a swelling of the semi-scrotum during standing, exercise, or during increased intra-abdominal pressure. Mild symptoms of pain, heaviness or discomfort in the testicle may also occur. These symptoms subside when lying down, as venous return is facilitated.

In a large varicocele, there may be a disorder in the sperm and, by extension, in fertility. The exact relationship between male fertility and varicocele exists in the fact that the testicles are 'heated' by the blood of the distended veins resulting in the destruction of the sperm. For this reason, the sperm improves after a surgical correction, as long as it is done in time. 

More rarely, it prevents the normal development of the testicle.

How is varicocele diagnosed?

Usually, varicocele is discovered accidentally by the patient himself or the doctor. On palpation of the testicle, a helical soft mass is found, which has no clear boundaries. It is characteristic that this mass decreases when the patient lies down, while it grows in the upright position and with the increase of pressure in the abdomen.

Confirmation is by ultrasound (color triplex) of the scrotum to identify the enlarged venous and venous blood reflux. In the presence of a right-sided varicocele, an imaging test is recommended to rule out other processing.

The classification of varicocele is:

  • Subclinical: It is not visible, neither at rest nor with an increase in intra-abdominal pressure, but it is diagnosed by ultrasound.
  • 1o degree: It is palpable with an increase in intra-abdominal pressure but not at rest.
  • 2o degree: It is palpable at rest, but not visible.
  • 3o degree: It is visible at rest.

How is varicocele treated?

Varicocele is treated surgically, but in most cases, it doesn’t need treatment. The categories of patients who need to be treated are:

  • In children with a delay in the development of the testicle, documented by ultrasound.
  • In men with affected sperm, who have clinical varicocele and infertility for at least 1 year. Infertility should not be due to other reasons.

Patients who experience pain, heaviness or discomfort in the testicle shouldn’t be pushed into the operating room.

In the surgical treatment, the veins that cause the varicocele are cut. Surgical repair can be performed open or laparoscopically.

As an alternative to surgical treatment, there is also embolization of the spermatic veins, which has more complications and is not widely applied.

When the operation is performed to correct infertility disorders, a repeat spermogram should be done 6-9 months after the surgery. Similarly, in the case of delayed development of the testicle, systematic monitoring through ultrasound is recommended.