Dr. Virendra Dhankhar
Varicocele: Causes, Signs, Test & Treatment
Varicocele is an enlargement of the veins within the scrotum. This factor leads to male infertility. Learn more from expert Dr. Virendra Dhankhar.
What are varicoceles?
Varicocele is a dilated vein. We all know our bodies have two systems, one which carries the pure blood from the heart to the organ, known as the artery. And one which carries blood back to the heart called vein. Because of some abnormality, the vein of the testicles are dilated and they hold the blood. And these dilated veins are called varicocele. This may be one of the factors leading to male infertility.
And what happens normally?
Vericolcle usually may be asymptomatic, they don’t give any reason. Sometimes they present with pain and heaviness in the scrotum. This is mainly after exertion, coughing, or strenuous exercises. Usually, when you lay down the pain gets relieved. You may feel like swelling in the scrotum ( अंडकोश की थैली ). These are usually presentations or the patient may present with infertility, abnormalities in semen parameters.
Sometimes these are detected during admission in the military or air force, and they are rejected because of these dilated veins.
What are the causes of developing this problem? Or What are the 5 signs of varicocele?
The causes are usually unknown. There are various and multiple factors responsible for varicocele. There is always a one-way passage, the impure blood always goes from the organ to the heart. And there are walls in the veins that prevent the indirection of the flow of blood. Due to some dysfunction of this wall leads to the backflow of this blood. Or these veins travel between the bones and the large intestines. So the vein is compressed because of the loaded (colon) between the vessel. So this may cause varicocele. But the actual cause is unknown, but there are many theories to explain it.
What are the five signs of varicocele?
The patient usually presents with pain or discomfort and heaviness in the scrotum. There may be a lump or a mass or a bag-like feeling in the scrotum. And signs of infertility may be present. These are all the presentations of varicocele.
What are the complications involved? Or Why does it feel like there’s something in my Ballsack?
If the person is fertile, usually it does not cause a lot of trouble and doe not lead to many issues. Long-standing varicocele can damage the testicles. One testicle decreases in size compared to the other one, which is called testicular abnormality.
Abnormalities in semen parameters, both in quality and quantity, may lead to infertility, if there is no sperm then it may lead to azoospermia. And if the fertility is low then it can also cause oligospermia, which is also infertility.
So these are the side effects of varicocele. Varicocele is more common on the left side compared to the right side. Sometimes the varicocele maybe because of the mass effect, any tumor in the kidney, which we compress because of the vessel.
There is a difference in anatomy on the left side and right side. The left side veins drain into the renal anyway at a right angle so that’s why the pressure is more. So because of the gravity effect as we are standing as mammals varicocele locker. In four-legged members, where there is no varicocele.
What does varicocele feel like?
It feels like a bag of worms in the scrotum. It feels like worms kept in a bag.
Does it really affect male fertility? Or Can a person with varicocele get a woman pregnant?
As I said there are various grades of varicocele. Grade one to grade four. The more dilation of the blood, the more the standing of the blood. If we talk about why the testicles are situated outside the scrotum whereas the ovaries in females are inside. The process of supreme generation requires less temperature than our body. So it’s a difference of 1-degree temperature.
The scrotum muscle is a thermoregulator. So because of this, there is the standing of blood in the veins which increases the temperature. As we know blood is warmer so because of the rise in the temperature the sperm quality and quantity both are affected. The varicocele in long run may decrease the size of the testes and may cause atrophy of the testicles. So this standing of blood leads to sperm abnormalities. Which affects fertility.
How can varicocele be diagnosed?
The diagnosis of varicocele is clinical, if we examine the scrotum will feel like a bag of varicocele. And we can when we asked the patient to cough, there is a backflow of blood which can feel. So this is known as a clinical varicocele. These clinical varicocele are significant there they can cause abnormality.
Then there is subclinical varicocele, which cannot be felt in a clinical examination so a Doppler test of the scrotum is done. In this, we examine the patient and tell him to increase the pressure and if there is a backflow of the blood, we measure the diameter of the way and according to the diameter of the vein. And grading is done according to the reflux on the wall, whether is fine or whether reflux is only on the wall. this is the grading in the varicocele. Clinical examination, ultrasonic examination, or color doppler of the scrotum are the diagnoses of varicocele.
How can varicocele be repaired? or How do you fix a varicocele without surgery?
Because of adolescent varicocele, the adult is not getting married. This varicocele requires preoptic repair, as it may affect fertility in the long run. So in adolescents varicocele even if they are asymptomatic needs to be corrected. There is only there is no medication to cure varicocele. This requires either surgical treatment or radiological treatment.
So when it should be treated?
The varicocele in adults like I said it should be treated. This is a reason for semen parameters or it has affected high-grade varicocele i.e. grade 3 or grade 4, or it has decreased the size of the testicles it needs to be connected.
The patient’s professional activities require it to be corrected. If it is significant worry some because of pain or even as the varicocele needs to be corrected.
And the treatment is surgical three ways of surgical treatment,
- One is known as a Laparoscopic Varicocelectomy.
- The second is known as a Microscopic Varicocelectomy and
- The third is Open Surgical Varicocelectomy.
So there are three surgeries. Which one is the best? What are the major differences?
In Microsurgical Varicocelectomy we make an incision about 1 inch big, we fo through the cord we set out the vessel and only preserve the artery and ligate only the vein, preserving the lymphatics. So this is the best. The recurrence rate in Microsurgical varicocelectomy is less than 1%, the formation of fluid collection around the testicles is 1% in Microsurgical varicocelectomy. And damage to the vessel is 1%.
The higher you go in the vein to ligate the vein, the more chances of recurrence are more. So in Laparoscopic varicocelectomy, the chances of recurrence are more. If it is bilateral and if we are not doing it because of fertility and laparoscopy is a better option than microsurgical.
Open Surgical Varicocelectomy
Open Surgical Varicocelectomy is nowadays outdated. In today’s day either it is laparoscopy or microsurgical.
Intervention Radiological Varicocelectomy
Another way of treating varicocele is Radiological Varicocelectomy. Like angiography we puncher the vein and pass the catheter in the testicular veins and lock the veins with a coil. Or we embolize the veins with a closing agent or the veins get collapsed. This is known as the intervention radiology procedure.
Does varicocele ligation affect testosterone production?
No. varicocele ligation or surgery, does not affect testicular production, they remain normal. So this, surgery wise is not responsible for this. There is no abnormality in sexual activity because of varicocele surgery. Only if the testicular artery is damaged during the surgery, it may lead to testicular atrophy, and if it’s done on both sides, then testicular atrophy may occur which may lead to decreased production of testosterone.
What is the cost of these surgeries? Or How much does varicocele surgery cost?
varicocele surgeries costs vary in India. And depends upon the reason to reason to why it is variable. On average, the Laparoscopic varicocelectomy at a small center may cause about 50-60 thousand and in the corporate, it may cause roughly about 1.5 lacs.
Microsurgical Varicocelectomy may be the same. On one side it may cause 70 thousand and bilateral it may cause 1.5 lac. It depends upon which hospital you are going to, the cost may be differed from place to place like Chandigarh to Delhi to Mumbai. The set-up, corporate setup may differ. And which procedure you are doing may also affect the cost. Roughly Microsurgical Varicocelectomy may cost about 70 thousand. It would be 1.2 lacs for both sides.
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