Varicocele

varicocele is an abnormal enlargement and elongation of the veins namely pampiniform venous plexus within scrotum which drains the testicles and is quite similar to the varicose veins in the legs. The testicular blood vessels originate in the abdomen and through the inguinal canal, the spermatic cord provide to the testis.

Types & Causes:

Idiopathic Varicocele:

  • Improper function of the valves within the veins along the spermatic cord like varicose veins.
  • Disrupted supply of oxygenated blood due to backflow of blood into the pampiniform plexus.
  • This results in increased pressures and if unattended even lead permanent damage of the testicular tissue .
  • Age Factor: Common in 15-30 years of age. Rare after 40 years of age.

Secondary Varicocele:

  • Compression of the venous drainage of the testicle.
    Malignant cause:
  • Age Factor: Above 40 years, malignancy of pelvic/ abdomen is the cause. is a definite Non-malignant Non-malignant cause:
  • Nutcracker syndrome: a condition in which the superior mesenteric artery compresses the left renal vein, causing increased pressures there to be transmitted retrograde into the left pampiniform plexus.
  • Renal Cell Carcinoma ( hypernephroma).
  • Retroperitoneal fibrosis / adhesions.

Symptoms:

  • Low sperm production.
  • Low-quality sperms.
  • Abnormal development of testicles.
  • Scrotum pain/ swelling.
  • Lump in the scrotum.
  • Fertility issues.
  • Size variation between testicles.
  • Drag- likeSharp/ dull discomfort
  • Increased discomfort due to physical exertion.
  • Relief when lie down.
  • Heaviness in the testicle(s) during long time standing.
  • Testicle Atrophy (shrinking).
  • Lowe testosterone levels.
  • Possibility of Benign prostatic hyperplasia, related urinary problems.

Diagnosis Tests:

  • Ultrasonography (color flow doppler).
  • Physical examination.
  • Valsalva maneuver.
  • Scrotal ultrasound- Doppler mode.

Treatment:

Cause based treatment:

  • Redirection of bloodflow: Varicocele repairment.
  • Fertility/ quality of sperm: IVF- In vitro fertilization.
  • Post Surgey Discomfort:  OTC painkillers like ibuprofen/ acetaminophen.
  • Sperm Count:  L-carnitine pills.
  • Valsalva maneuver/ pain: (Daflon) Micronised purified flavonoid fractions.
    Non- Surgical: Cathedral insertion in gat-goren method.
    Surgery:
  • Open S.
  • Laproscopic surgery.
  • Percutaneous Embolizatiom.

Home Remedies:

Athletic supporter for pressure relief.

Possible Side- effects of Treatment:

  • Hydrocele around the testicles.
  • Testicular atrophy.
  • Infection.
  • Damaged artery.
  • Recurrent varicoceles.

Prevention & Precaution is Better than Cure:

Regular check-up and tests.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient.