The varicocele represents an enlargement of the veins at the level of the scrotum (the sac in which the testicles are located); it develops over time and it is easily diagnosed. This health problem is similar to varicose veins in the legs and it can lead to reduced sperm production and quality, which sometimes causes infertility or even shrinking/stagnant testicle development. From a statistical point of view, 15% of the adult male population faces faces the risk of developing varicocele.
Usually the varicocele does not produce any sign or symptom, but sometimes it can cause pain that can vary from sharp to a slight discomfort, it can intensify when you stand up or when you perform physical exercises, it can get worse during the day, it gets better when you sit back, and it affects fertility. In the absence of treatment, the varicocele can enlarge and become visible and lead to a swollen appearance of the testicle, almost always on the left side, so that a swelling will be visible in one of the testicles, respectively enlarged/twisted veins in the scrotum.
The exact cause of the appearance of varicocele is not known, but it is likely to form when the valves in the veins located in the spermatic cord (transport blood from and to the testicles) prevent good blood circulation (which accumulates in the veins), causing their dilation. It is often formed during puberty and it appears on the left side as a result of the positioning of the testicular vein (the abnormal enlargement of the veins is highlighted). If the physical examination is not conclusive, the doctor can recommend a scrotal ultrasound to rule out other causes, such as a tumor; this ultrasound helps with the measurement of the spermatic veins and it provides an overview of the condition. After the diagnosis, the clinical grade is established, which starts from 1 to 3, depending on the size of the swelling in the testicle; the treatment is not influenced by this grade.
In order to establish an accurate diagnosis, the urologist will perform a physical examination that may highlight a mass present above the testicle; if it is big enough, it can be felt by palpation. To identify a smaller varicocele, the Valsalva maneuver is applied.
There are situations in which treatment is not necessary for varicocele, many men being able to procreate without medical intervention. If pain, testicular atrophy or infertility are present or if you are considering assisted human reproduction techniques, surgery may be necessary. The operation is intended to seal the affected vein to redirect the blood flow into the normal veins. The surgical intervention for the treatment of varicocele is called varicocelectomy and can be open (classical operation) or laparoscopic; the patient is discharged the same day. There is also the option of percutaneous embolization, which involves the creation of a blockage in the testicular veins that interrupts the blood flow and repairs the varicocele, but it is not very often used in medical practice. After treatment, fertility or sperm quality can be improved, making it possible to use in vitro fertilization or other reproductive techniques.
As for the complications associated with the lack of appropriate treatment, they include the shrinking of the affected testicle (atrophy) and infertility. The varicocele can keep the local temperature in or around the testicle too high, affecting the formation, the motility and the functioning of the spermatozoa.