Varicocele – Causes, Diagnosis and its Treatment
Varicocele is a commonly prevalent male anatomic anomaly wherein the small veins surrounding the scrotum enlarge unnaturally. On an average, every 1 out of 7 male suffer from Varicocele and half of them are likely to have it on the left side of the scrotum. Although Varicocele is mostly asymptomatic and rarely causes any discomfort, there can be some evident symptoms in advanced stages and can be indicative of lowered fertility in men.
There is no apparent health risks connected with Varicocele. However, Varicocele is often credited for reduced fertility and quality of sperm in men. Most men are at a risk of developing Varicocele between the age of 15 and 25 years. However, those men who develop sudden symptoms of Varicocele after the age of 40 may have other underlying causes which could be leading to development of Varicocele.
Varicocele is a condition very similar to varicose veins in legs. The condition develops due to faulty valves in the veins. A typical vein has valves placed at regular intervals to maintain one-way flow of blood towards heart. However, these veins can sometime fail to regulate the blood flow against the pressure of gravity and dilate due to backward flow and consequent pooling of blood.
A common cause of Varicocele is lifestyle and is very difficult to manage. Men who have a sitting or standing job for long intervals of time have a higher tendency of developing mild cases of Varicocele.
Another prominent cause of Varicocele is large venal blockage in the abdominal area which is connected to the scrotum via the spermatic cord. If there is blockage and increased blood pressure developing in the large veins of abdominal area, then the consequent backward flow of blood can defect the valves in the small veins in the scrotum.
Lastly, as the vein network of left testicle is directly connected with the renal veins; the development of varicocele in the left side of scrotum may be indicative of carcinogenic growth in renal tissue.
Varicoceles are mostly asymptomatic and therefore, many a times affected individuals may not even realise that they have this condition. The diagnosis of clinical grade Varicocele is done by doctors upon scrotal examination. The methods used for diagnosis of varicocele are –
- Ultrasonography – it can show the vein enlargement greater than 2mm
- Venography – considered the most reliable but is invasive in nature and involves catheterization
- Color flow Doppler ultrasound – can show the flow of blood
- CAT scan, thermography and scintigraphy also find limited diagnostic use
As the blood can recede from the small veins of scrotum upon lying down, the best way of Varicocele diagnosis is in the standing-upright position. In more than 50% of the men affected with Varicocele, the condition exists only in the veins above the left testicle. In the rest, the condition is likely to exist over both testicles. The reason for this anatomical occurrence is that the arrangement of veins over the left testicle is very different from the arrangement over the right testicle.
In case of sub-clinical Varicocele, visual diagnosis is also possible as the enlarged veins are clearly visible over the affected scrotal area. In quite advanced stages of Varicocele, the outward appearance of scrotum seems like it is infested with worms. Some of the commonly seen symptoms of Varicocele are –
- A feeling of dragging or dull ache in the testicles after a hectic day, especially before bed-time.
- In addition to visible enlargement of veins, sometimes veins can also be felt on palpation,over the scrotum
- Heaviness can also be felt by the patient in the testicles over an extended period if the condition is worsening
- Shrinkage of testicles can be seen in teenage boys who develop Varicocele at an early age
- Reduced sperm count and sperm motility can also be symptoms of Varicocele. Although this may not always be the case in men with reduced fertility.
Treatment for Varicocele
As the condition is mostly not associated with any lasting damage and discomfort, the initial advice of a physician may be to leave the Varicocele as it is. However, since the condition can at times be associated with infertility as well as development of tumours in renal or abdominal areas, the treatment of Varicocele as well as further investigation of causes is advised by physicians. Commonly employed treatments for Varicocele include –
- Varicocelectomy: This invasive surgical treatment involves insertion of a catheter in the vein to inject fluids and close off malfunctioning veins. It is performed under local anaesthesia and patient can return to normal activities within 24 hours.
- Embolization: This nonsurgical procedure involves interventional radiology wherein abdominal veins are obstructed from pressurising the testicular veins with the help of a small flexible catheter. This alternative treatment is preferred for varicocele post-surgery recurrence.
- Medication: L-carnitine and Micronised Purified Flavonoid Fractions (MPFF) have a mild effect of varicocele pain and symptoms.
- Natural treatments like improvement of blood circulation, lowering blood viscosity, alleviating constipation, etc.