A varicocele, pronounced var’e-ko-seel, is a network of dilated blood vessels, or varicose veins, in the scrotum. For unknown reasons, varicoceles usually occur in the left testes. Varicoceles are a relatively common condition that tend to occur in young men, usually during the second or third decade of life. This condition affects approximately 15 to 20% of the general male population and up to 40% of infertile males.
Normally, oxygenated blood flows to the testicles via an artery, and deoxygenated blood flows out via a network of small veins that drain into another vein, and is eventually carried back to the heart. During this process, backflow to the testicles is prevented by a series of one-way valves in the vein. In some individuals, however, these valves do not work well. As a result, the blood flows in reverse and causes “back pressure” to stretch and enlarge the network of small veins around the testes, forming a varicocele.
Many times a varicocele is silent and does not cause symptoms. However, some varicoceles cause a dull or aching pain especially when the person has been in upright position for a long time. Heavy lifting may also cause pressure build up in the varicocele.
In some individuals, a varicocele may cause decreased fertility or infertility. As many as 40% of men with decreased fertility have a varicocele. A commonly accepted theory is that the varicocele raises the testicular temperature and adversely affects the sperm count and quality. More than half of men with decreased fertility will have improvement in the sperm count and quality after treatment of the varicocele.
In some men, varicoceles can cause shrinking (atrophy) of the testicles. In many cases, when the varicocele is treated on the affected side, the testicle may return to normal size.
It is best to catch a varicocele before it can cause major problems, such as infertility. Self-exam of the scrotum is the best way to diagnose a varicocele early. A varicocele can feel like a “bag of worms”, and is usually found in the left testicle. The majority of varicoceles are detected by a doctor during a health checkup.
In many cases, the varicoceles cause no symptoms and do not need to be fixed. However, if there is associated pain, decreased fertility, or testicular shrinking, treatment may help. All adolescents with varicoceles should be treated to avoid future infertility.
Varicoceles may be treated surgically by a urologist (varicocelectomy) or by a minimally invasive method (varicocele embolization) by an Interventional Radiologist.
Embolization requires no stitches or general anesthesia and only a 1/4 of an inch incision. Nearly all the patients can be treated on an outpatient basis and may return to normal activities in two to three days. Surgical treatment requires an incision and may require several days or even weeks to return to full activities. Studies have shown that embolization and surgery are equally effective.
Regardless of the treatment, the varicocele may recur and may require repeat treatment. If the varicocele has been previously treated with surgery, embolization is still an option. If recurrence occurs after the embolization, embolization can generally be repeated. If a repeat embolization fails, surgery can still be performed.
Varicocele embolization is usually performed on an outpatient basis under sedation and local anesthesia. A small catheter (tube) is inserted into a leg vein near the hip or neck vein through a tiny skin incision. This tube is placed into the varicocele vein under X-ray guidance. Small amounts of X-ray dye (contrast) are injected to confirm the position of the catheter. Then tiny coils made of stainless steel or platinum, balloons, or other materials are inserted in the vein to block it and stop the backflow, or pressure, in the varicocele. Blood can still exit the testicle through other normal pathways. Once it is confirmed that there is no flow in the affected vein, the catheter is removed.
There is a 90% success rate with embolization, and of those with success, about 10% may experience late recurrence. These results are the same as those achieved with more invasive surgical techniques. Varicocele embolization has been performed for over 25 years and has an excellent long-term safety record. Its safety and effectiveness has been shown in very large trials.
As with any treatment, there are potential complications associated with this procedure. Minor complications such as bruising at the entry site, mild backache, or nausea (rare) may occur. Complications associated with surgery such as hydrocele (collection of fluid in the testes), infection, or loss of testicle are exceedingly rare with an embolization procedure.
Embolization does not affect sexual function. Sexual activity may be resumed the day after the embolization. However, since it takes sperm about three months to mature, improvement in fertility may take three months or longer.
The best treatment for a varicocele depends on whether or not you have had prior treatment for a varicocele. You should discuss your treatment options with your physician. Some questions to ask:
The cost is similar to surgery. Most insurance companies pay for the procedure. However, coverage depends on the particular insurance company and should be discussed with them.
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