What is a Varicocele?
Varicoceles are abnormally dilated veins in the scrotum that heat up the testicles.
Who gets Varicocele?
- 15% All Man
- 35% Man with primary infertility
- 80% Man with secondary infertility
Gorelick & Goldstein, Fertil Steril 59:613-616, 1993
Varicocele is the most common cause of male infertility. Studies have shown that varicoceles can cause progressive testicular damage over time . It appears that surgical repair of varicocele not only halts this decline, but can often reverse it.
What method of varicocele repair is best?
| Technique | Spontaneous Pregnancy Rates (%) |
Recurrence Rates (%) |
Hydrocele Formation (%) |
|---|---|---|---|
| Palomo | 37.69 | 14.97 | 8.24 |
| Microsurgical Subinguinal | 41.97 | 1.05 | 0.44 |
| Laparoscopic | 33.2 | 12.7 | |
| Macroscopic Inguinal or Subinguinal | 36 | 2.63 | 7.3 |
Cayan, Shavakhobov & Kadioglu. J Androl 30 (1), 2009.
Microsurgical subingunial varicocele repair is currently the most popular approach. It allows the surgeon to identity the testicular artery, lymphaticas and small veins to minimize the occurrence of complication like hydrocele or varicocele recurrence.
Microsurgical varicocelectomy is typically done under a light general or regional anesthesia, and the patient can go home the day of the surgery.
Results
Facts about Varicocoele you must know
- Varicocele means dilatation or enlargement of veins of the testis. As a result, blood tends to pool in the veinsof the testis and results in increased temperature of the testis.
- It occurs in about one in six males.
- 15 percent of men have a varicocele.
- Among men evaluated for infertility, about 40 percent have a varicocele in at least one testicle.
- solated right sided varicoceles could be an indication of vena cava obstruction such as from a right renal cancer venous tumour thrombus. Especially in varicocele developing after the age of 40.
- Varicoceles are believed to be caused by defective valves in the veins within the scrotum, just above the testicles. Normally, these valves regulate the flow of blood to and from the testicles. When normal flow doesn’t occur, the blood backs up, causing the veins to dilate (enlarge).
- In about 85 percent of cases, it occurs in the left testicle area.
- Usually noticed during a routine physical exam
- Commonly person will have dull ache or feeling of heaviness in the testicle, which gets worse during the day, particularly in hot weather or after physical exertion.
- Sometimes dilated veins in the scrotum can often be felt or seen, and the testicle is smaller on the varicocele side.Typically,large varicoceles are known as “bag of worms”
- A varicocele can lead to testicular atrophy, or shrinkage.
- Can cause infertility in the males as it decreases sperm production and alters the motility and morphology of the sperms by raising the temperature in the testis.
- Also decreases testosterone production in the testes which can cause erectile dysfunction(impotency)
- Most of the doctors treating infertility in couple fail to identify a varicocele which could be the cause of male infertility.
- 18% of men referred to one infertility centre after various costly assisted reproductive procedures(IVF/ICSI), were ultimately found to have significant varicocele.
- Usually identified by an expert during physical examination of the patient on asking him to cough or strain.
- Doppler ultrasound is the most reliable investigation to confirm varicocele.
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There are three grades of varicocele:
- Grade 1: The smallest type, this is not visible, but a physician can feel it if they use a Valsalva manoeuvre.
- Grade 2: This is not visible, but it can be felt without a Valsalva manoeuvre.
- Grade 3: The varicocele is visible.
- There are no effective medical treatments for varicocele.
- Subclinical varicocele (Grade 1) does not require treatment.
- Grade 3 varicoceles can be treated by Surgery
- Microscopic Varicoceletomy (removal of varicocele using high power microscope) which is the gold standard treatment as it minimizes the risk of injury to the blood vessels of the testis and decreases the chances of recurrence.
- Varicocelectomy leads to improvement in the serum testosterone level in >80% of patients.
- Following surgery, approximately 70% have improved semen parameters, and 40% to 60% have improved conception rates.
- This improvement in semen quality will typically become noticeable at approximately 3 to 4 months after surgery and become final at 6 months.
- Most patients with pain from a varicocele will have a major improvement in pain, or even complete pain relief.