Varicocele of the Testicles


A varicocele is literally a collection of varicose veins surrounding a testicle. This common condition affects up to 20% of males.

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The majority of men with varicose veins still have normal sperm counts and sperm morphology and their fertility is not adversely affected.

When a man's fertility is being investigated, the causes of male infertility may be due to a low sperm count, which is a direct result of varicose veins causing high temperatures in the testicle.

The condition is found almost exclusively on the left hand side. It is due to the left testicular vein empting vertically into the renal vein a long way up.

The varicosities form when the valve system between these two veins fail, so that blood falls backwards into the testicle under the pull of gravity.

The right testicular vein enters directly into the major trunk vein, at an angle, further down. Therefore its valves do not have to support the same weight of blood as those in the left testicular vein. It is thus much less likely to fail. The reverse flow of blood stretches and may enlarge the tiny veins around the testicle.

A varicocele can be described as a warm tangle of worms in the scrotum.




Infertility in Males


A varicose vein contributes to male infertility or sub fertility. A varicocele can trigger a fall in sperm count, through keeping hot blood pooled within the scrotum, rather than draining it away.

Any increase in temperature affects sperm formation, which ideally needs a temperature of 4-7 degrees C, less than core body temperature.

Varicoceles are linked to between 30-40 percent of cases of male infertility.

A varicocele will be surgically excised, if sperm count is compromised in a man trying to have children.  A semen analysis is the only conclusive means of assessing if the varicocele has affected a male. Infertility under this condition may extend beyond 2 years.

Sperm count, decreased sperm motility and an increase in the number of deformed sperm, can be expected.

Sperm will be affected when a raise in temperature is experienced. Studies have shown, that there is a significant improvement, as much as 70 per cent, in the quality and/or quantity of sperm production, after the testicles have undergone varicocele repair.


Signs of varicoceles


In many cases, there are no symptoms and the condition is harmless. The testicles can function normally.

Symptoms from varicose veins can be experienced as an aching pain or discomfort, when standing or sitting for an extend period of time and pressure builds up in the veins.

Lifting heavy objects can make the symptoms worse. Painful varicoceles are prominent in size, displaying as a large scrotum. The veins should be removed or treated if they ache or cause discomfort. More often than not, they are left in place, if no pain or infertility is experienced.

Atrophy, or shrinking, of the testicles is another sign to look out for. When the affected testicle is smaller than the other, repair of the varicocele is recommended.  The repaired testicle will return to normal size after a period of time.

An athletic support can be worn to relieve discomfort if no surgery is performed.


Diagnosis


These veins can be detected in the testicles, during a physical examination.

A reliable diagnosis will be made with ultrasound, which shows the dilatation of vessels of the pampiniform plexus to greater than 2mm.  A Ultrasonography - color flow doppler, needs to be performed by a highly trained and experienced radiologist, who will diagnose the condition, with monitoring of the backflow in the right and left spermatic veins.



Treatments


A urologist will decide on the correct treatment plan, according to the severity of the condition, as well as if pain is experienced. Infertility will also be taken into account, for a male wanting children.

Varicocelectomy, the surgical correction of a varicocele, is normally performed as an outpatient basis. There are three types of surgery which may be performed. Groin, abdominal or below the groin. Depending on the surgery performed and if necessary, a scrotal support can be worn for some time after surgery.

An alternative to surgery correction is a minimally invasive treatment called embolization.

This procedure is performed by a radiologist. A small wire is passed through a peripheral vein and into the abdominal veins that drain the testes. Recovery time is normally less than with a surgical procedure. Fewer recurrences of the condition are experienced using this treatment method.

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The removal of the varicocele can lead to normal testicular temperatures and thus an increase in sperm production, which is necessary in the treatment of infertility. An excellent rate of success can be expected once varicose veins have been identified and treated.

Veins in the testicle causing infertility in men is a treatable condition.




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