What is Varicocele? Varicocele Symptoms and Surgery

Varicocele is a health problem that occurs all over the world and affects men. It is not life-threatening, but it can affect a person’s comfort and can be considered a risk factor, especially for those who want to have children. Varicocele may contribute to almost 40% of men experiencing infertility.

What is Varicocele?

The reproductive system in men is responsible for the production, storage and transportation of sperm. Sperm is the male reproductive cell that fertilizes the egg in a woman. In men, sperm is stored in units called testicles that synthesize the hormone testosterone. A healthy man has two testicles. Scrotum is the name given to the sac that holds the testicles. Sperms mature in the spiral tube (epididymis) located behind each testicle. Sperms travel from the epididymis to the prostate through a tube called the vas deferens. The prostate is a gland located in the front part of the intestines, just below the bladder and surrounding the outlet of the bladder. It is responsible for the production of the fluid that protects sperm.

When ejaculation occurs, the sperm and the protective fluid secreted by the prostate form semen, which passes through the urinary tract and is expelled from the tip of the penis. In order for healthy sperm production and sperm storage, the temperature in the testicles needs to be lower than body temperature. Before blood reaches the testicles, there are vessels in the testicular artery that act as counter-current heat exchangers and carry low-oxygen blood from the testicles. These vessels, located in the scrotum and called the pampiniform plexus, help the production of quality sperm by keeping the temperature in the testicles constant. Varicocele is a varicose-like formation that develops as a result of expansion of the pampiniform plexus. It usually does not cause any serious problems and is considered harmless. However, in some cases, it may cause pain or shrinkage of the testicles. Expansion of the vessels in the scrotum can lead to overheating of the testicles and, accordingly, a decrease in sperm production and a decrease in their quality.

What are the symptoms of varicocele?

Varicocele usually progresses without any symptoms. Although it is not considered a serious problem, it can make a difference in sperm quality and number, especially in men who want to have children. Varicocele research is usually performed in men who face unexplained infertility. Symptoms of varicocele may include:

• Varicocele usually develops unilaterally. Since the rate of occurrence is high in the scrotum veins, where oxygenated blood is carried, a soft swelling can be observed mostly on the left side and on the testicle. This swelling may manifest itself as a worm-like structure as a result of the dilation and twisting of the vessels.
• A persistent, dull pain or feeling of heaviness in the testicles, scrotum, or groin (usually improves when you lie down)
• Pain and discomfort that worsen in hot weather or after exercise,
• Shrinking of the testicle affected by varicocele.

To diagnose varicocele, the urologist examines the patient’s medical history, obtains information from the patient about the symptoms and performs a physical examination. When he suspects varicocele, he may order the following tests:

• Pelvic Ultrasound: Pelvic ultrasound is a type of imaging test performed to examine the vessels in the testicles in detail. The appearance of the veins is examined externally on the testicular skin tissue with the help of an ultrasound device.
• Semen Analysis: Varicocele can affect sperm quality and count. Sperm characteristics are investigated from the patient’s semen.
• Blood Test: In case of varicocele, changes may occur in the patient’s FSH (follicle stimulating hormone) and testosterone hormones. Varicocele can be diagnosed by detecting these changes with a blood test.

If there is a varicocele, its degree is calculated to determine the severity of the disease:

• Grade 0: Testicular vasodilatation noticed on ultrasound. The doctor does not feel vascular enlargement with physical examination, but the presence of varicocele can be mentioned on ultrasound.
• Grade 1: The doctor uses a method called the Valsalva maneuver during the physical examination of the varicocele. In this method, the patient is asked to take a deep breath and try to exhale by closing his mouth and nose. If swelling of the veins is observed when this method, called the Valsalva maneuver, is applied, first-degree varicocele can be mentioned.
• Grade 2: If swollen veins are observed in the testicles even without the patient performing the Valsalva maneuver, grade 2 varicocele is diagnosed.
• Grade 3: Swollen veins in the testicles can be seen and easily felt during a doctor’s physical examination.

What Causes Varicocele?

There is no specific risk factor as to why varicocele develops and it is not possible to talk about a clear reason. Each testicle is enclosed in a vascular stalk, namely the spermatic cord, which consists of testicular nerves, the canal that transfers sperm called the vas deferens, and testicular arteries and veins. It helps keep the testicles stable. Healthy veins have one-way valves. These valves, which act as opening and closing functions, move blood from the testicles to the scrotum and send it back to the heart. In some cases, the valves may not function properly and blood may accumulate in the vessels, causing dilation. Enlarged veins can cause varicocele over time. Possible factors that can cause vasodilation may include:

• The left testicular veins are in an upright position. Blood may gush out forcefully from veins in the upright corner, causing the valve valves to malfunction. This can cause blood to accumulate and the veins to gradually expand and become twisted.
• The development of any lesion in the right or left testicular veins or compression of the vein by organs close to the testicle, such as the intestines, may cause obstruction in the testicular veins. Over time, the blockage can cause damage to the valves, leading to blood pooling and vasodilatation.
• Nutcracker Syndrome is a condition that occurs as a result of compression of the left renal vein by the aorta and superior mesenteric vein (intestinal artery). This compression may cause blood flow to the left testicular vein to flow more forcefully, causing damage to the valve system and enlargement of the vein.

Varicocele can be seen at almost any age and is usually a congenital condition. In most cases, it is noticed during puberty and can prevent the testicles from developing properly.

How is Varicocele Treated?

Varicocele treatment varies depending on the degree of vascular enlargement. In low-grade varicocele, the following options are recommended by the doctor:

• If varicocele does not bother the patient and there is no problem with sperm quality, treatment may not be needed.
• Some activities that cause discomfort in the testicles may need to be avoided. For example, standing or exercising for long periods of time can cause pain and discomfort in the testicles. In this case, the doctor may recommend using tight underwear or a clothing product called a sports brace to keep the testicles stable.
• Ice application may be recommended to reduce pain and discomfort in the testicles. Cold can help dilated veins constrict. Instead of applying ice directly to the skin, you can wrap the ice in a clean towel and apply it to the painful testicles for 15 minutes.
• The doctor may recommend treatments such as varicocele surgery or varicocele embolization for advanced conditions, especially those that cause differences in sperm quality.

How is Varicocele Surgery Performed?

Varicocele surgery, called varicocelectomy, is a surgical procedure performed in a hospital environment and under general or local anesthesia. In the surgery performed by the urologist, the doctor surgically enters the abdomen or pelvis. Expanded veins are cut and their ends are tied. Thanks to microsurgery, a surgery performed by enlarging the vessels under a microscope, the enlarged blood vessels are closed and blood flows through other vessels. Another method used in varicocele treatment is varicocele embolization. In this method, the patient’s armpit or groin is anesthetized and a thin sheath is placed into the vein. With the help of angiography device, it is determined which vessels are enlarged. Then, the enlarged veins are closed using special wires.

What Should Be Considered After Varicocele Surgery?

It is important for the patient to rest for a week following varicocele surgery. The area where the surgical procedure is performed must be protected from impacts and dressed regularly. It is recommended that the patient not take a shower during this period. Depending on the condition of the surgical wound, your doctor may decide to remove the dressings and take a shower. Lifting heavy loads and performing strenuous sports activities for a month after the surgery may prolong the healing process. It is natural to experience swelling in the testicles or testicles in the first days after the procedure. Fluid accumulation called hydrocele may be observed around the testicle. In this case, a second surgical procedure called hydrocele surgery may be required.

It is important to have regular check-ups to prevent sexual health from being affected and to protect against circulatory system problems in old age. If there are varicocele risk factors or symptoms, especially in reproductively competent individuals, it is recommended to consult a specialist as soon as possible.