Urology

Varicocele

Varicocele affects approximately 15% of the male population and is more common in adolescents and young adults.

What is varicocele?

Varicocele is the dilation of the veins that drain blood from the testicles, called spermatic veins. These veins are located in the spermatic cord, along with the spermatic artery and the vas deferens. Varicocele occurs when the valves inside the spermatic veins do not function properly, allowing blood to pool and causing the veins to dilate. This can affect testicular health and, in some cases, fertility.

Varicocele generally develops on the left side of the scrotum, although it can affect both sides or, rarely, only the right side.

Hombre sentado en consulta médica. Varicocele, inflamación de venas en el escroto

Varicocele symptoms

The presentation of varicocele is highly variable. Some men may not experience any symptoms; more often, it is discovered during a routine physical exam or fertility evaluation. When symptoms are present, they may include:

Pain:

testicular pain associated with varicocele can range from mild discomfort to a dull, constant ache. It may worsen when standing or during physical exercise, and is usually relieved when lying down.

Swelling:

in some cases, a lump or mass of dilated veins can be felt in the scrotum, often described as a “bag of worms.”

Testicular atrophy:

in some cases, the affected testicle may be smaller than the other. This is because altered blood flow can affect the growth and development of the testicle.

Infertility:

Although not all men with varicocele experience infertility, it is a common cause of low sperm production and quality.

It is important to note that the severity and presentation of symptoms can vary significantly from person to person.

Causes of varicocele

The exact cause of varicocele is unknown. It is believed that it may be related to dysfunction of the valves within the spermatic veins. The function of these valves is to prevent blood from flowing backward. When the valves do not function properly, blood accumulates in the veins, causing them to dilate.

Risk factors for varicocele

No clearly established risk factors have been identified. However, it has been observed that adolescents and young adults with scrotal pain, infertility problems, or abnormal testicular findings are at higher risk of developing varicocele.

Varicocele classification

The classification of varicocele helps doctors determine the severity of the condition and guide treatment decisions. There are several classification systems, but one of the most widely used is the clinical classification based on size and palpation, which is divided into three grades: 

Grade I (subclinical):  the varicocele is not palpable or visible to the naked eye. It can only be detected through imaging tests, such as Doppler ultrasound. It is often discovered incidentally during a routine physical exam or fertility evaluation. Although it is the mildest grade, Doppler ultrasound can reveal venous reflux and dilation of the spermatic veins.

Grade II: the varicocele is only palpable when standing, especially during the Valsalva maneuver. It is not visible to the naked eye. When performing the Valsalva maneuver, the increase in intra-abdominal pressure accentuates venous reflux and dilation of the veins, making them palpable. The doctor may feel the dilated veins as a “lump” or “mass” in the scrotum.

Grade III: a varicocele is visible to the naked eye as a swelling in the scrotum, even without performing the Valsalva maneuver. The dilated veins are easily visible and palpable. This is the most severe grade and is often associated with a higher risk of complications, such as testicular atrophy and infertility.

Although there are different classification systems, they are all based on the evaluation of the size and palpation of the varicocele, complemented by the information provided by Doppler ultrasound.

Varicocele complications

The most significant complication of varicocele is male infertility. Dilation of the veins can increase testicular temperature, which negatively affects sperm production and quality. Other less common complications include testicular atrophy and chronic pain. It is essential to seek medical attention if a varicocele is suspected, especially if fertility problems are experienced.

Varicocele diagnosis

The diagnosis of varicocele is based on a combination of clinical evaluation and imaging tests.

Physical examination: the process begins with the examination of the scrotum. The doctor may ask the patient to perform the Valsalva maneuver (try to exhale without allowing air to escape through the nose or mouth). This maneuver increases abdominal pressure and facilitates the detection of varicoceles that are not evident at rest. During the physical examination, the doctor palpates the scrotum to assess its size, consistency, and the presence of dilated veins.

Scrotal Doppler ultrasound: it is the imaging test of choice to confirm the diagnosis of varicocele. This test uses high-frequency sound waves to create images of the veins in the scrotum and assess blood flow. Doppler ultrasound can detect venous reflux, which is the retrograde flow of blood towards the testicles, characteristic of varicocele. In addition, it allows for the measurement of the diameter of the veins and assessment of the presence of other scrotal abnormalities.

Other diagnostic tests include: in some cases, additional tests, such as a semen analysis, may be necessary, especially if the patient has fertility problems. Semen analysis evaluates the quantity, motility, and morphology of sperm, and can reveal abnormalities associated with varicocele.

Varicocele treatment

Varicocele treatment is individualized according to the symptoms, the severity of the condition, and the patient’s desire to have children. In many cases, especially in asymptomatic or mildly symptomatic varicoceles, no treatment is required. However, if the varicocele causes pain, testicular atrophy, or fertility problems, treatment may be considered. Treatment options include:

Observation: in asymptomatic or mildly symptomatic varicoceles, observation can be chosen, monitoring the evolution of the condition through physical examinations and periodic ultrasounds.

Conservative management: to relieve pain and discomfort, over-the-counter pain relievers and the use of a scrotal support may be recommended.

Percutaneous embolization: non-surgical procedure performed through a small catheter inserted into a vein in the groin or neck. The catheter is guided to the affected veins in the scrotum, where a substance is injected that blocks blood flow. This technique is less invasive than surgery, but it has a slightly higher recurrence rate.

Surgery (varicocelectomy): surgery is the most effective treatment for varicocele and is recommended in cases of persistent pain, testicular atrophy, or infertility.

Postoperative recovery from varicocelectomy is usually quick, and most patients can resume their normal activities within a few days. However, it is important to follow the doctor’s instructions and avoid intense physical activity for a certain period of time. Possible complications of the surgery include infection, bleeding, scrotal hematoma, hydrocele (fluid accumulation around the testicle), and recurrence of the varicocele.

HM Hospitales has a Urology Department that is dedicated to the study and treatment of the main urological diseases, including male genital problems such as varicocele.https://www.hmhospitales.com/especialidad/urologia/

Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect that you may have a varicocele, consult a specialist to obtain an accurate diagnosis and a treatment plan tailored to your needs.