Varicocele is a condition of abnormal enlargements of the veins in the spermatic cord that carry the blood from testes to heart. They mostly occur during puberty and are more common in men between 15 and 25 years. Varicoceles happen more often on the left testicle, sometimes they occur on both sides.
Blood flow in these veins is regulated by group of valves that ensure one-way blood flow, from testes to heart. Any abnormality or impairment in these valves may cause backward flow of blood and pooling of blood in veins. This may cause swelling and widening of veins and the condition is called as varicocele. Varicocele is similar to varicose veins, which are common in the legs. In some cases, it might damage the testicle or decrease the sperm production, leading to infertility in men.
In most cases, men diagnosed with a varicocele have no symptoms and in other cases individuals may present with symptoms such as dull ache and discomfort in the testicle, enlarged twisted veins in the scrotum and feeling of heaviness in the scrotum. The symptoms may worsen with physical exertion, hot weather, sitting or standing for a long time.
Varicocele may be diagnosed during routine examination. The groin area (area where the upper thigh meets the trunk), including the scrotum and testicles are examined. Non-tender twisted mass along the spermatic cord is felt and have been described as having a “bag of worms” because of the appearance and the way they are felt.
Varicocele is generally harmless and often requires no treatment. Anti-inflammatory medications are prescribed, if varicocele is associated with pain and swelling. Wearing snug underwear or a jock strap may offer relief from pain and discomfort. However persisting or severe pain necessitates medical intervention.
Varicocelectomy is a surgical procedure to correct a varicocele. The procedure is performed under anesthesia by an urologist. An incision or cut is made usually in the lower abdomen, and the affected abnormal veins are tied off, to redirect the flow of blood into other normal veins. Ice packs should be kept on the area for the first 24 hours after surgery to reduce swelling.
An alternative to surgery is percutaneous embolization. It is a minimally invasive treatment for varicocele which is performed under anesthesia. A catheter, small hollow tube, is placed or inserted into a vein in the groin or neck area. After radiographic visualization, the tube is moved into the varicocele, and a tiny coil is passed through the tube. The coil blocks the blood flow to the abnormal vein, and sends it to normal veins and rectifies the abnormal blood flow. Ice packs are applied to bring down the swelling.
Risks and Complications
Complications following varicocele repair include infection, hematoma (blood clot formation), injury to the scrotal tissue or structures, injury to the artery that supplies the testicle and recurrence of varicoceles.