VARICOCELE

Varicocele is a clump of enlarged and engorged veins that develops in the spermatic cord within the scrotal sac. The spermatic cord is made up of veins, arteries, lymphatic vessels, nerves, and vas deferens.

If the valves that regulate bloodflow from these veins are defective (usually from birth), blood does not drain from the testicles efficiently, causing swelling in the veins above and behind the testicles.The pooling of blood in the engorged vessels results in warming of the testis.


A varicocele can develop in one or both testicles, but in about 85% of cases, the left testicle is involved.
A varicocele is found in approximately 15% of  men.  In men evaluated for infertility , varicoceles are found in approximately 40% of patients.

Varicocele affects semen quality because of increased heat to the testicle. The dilated veins allow warm blood from the abdominal cavity to flow around the testicle. This causes overheating of the testicle which then impairs its function. Commonly, a low sperm count, poor movement, and abnormally shaped sperm are found in men with varicoceles. A varicocele surrounding 1 testicle may affect the testicle on the opposite side of the body. A varicocele may also lead to impaired growth of the testicle and thus the testicle on the side of a varicocele may be smaller than the other..

Signs and symptoms

Most men with varicocoeles have no symptoms and they are diagnosed on routine physical examination or during infertility work up.

Signs and symptoms include the following:

• Pain in the testicle
• Feeling of heaviness or discomfort in the testicle(s) 
• Infertility
  
• Shrinkage of the testicle(s)
• Visible enlarged vein or vein that is able to be felt

 Large varicoceles are easily identified on physical examination; they have the classic "bag of worms" appearance surrounding the testis.

Grading of varicocoeles:

• Grade 1-  varicocele that is palpable only during straining (Valsalva maneuver).
• Grade 2 - varicocele in which the lesion is palpable without a Valsalva maneuver.
• Grade 3 - varicocele that is visually detectable

Diagnostics:

Ultrasound is the examination of choice for investigating varicoceles, and it remains the most practical and most accurate noninvasive technique.

Treatment

If the varicocele causes pain or decreased size of the testis (rare) or if the condition is causing infertility (most common), surgery is recommended.

Urologists correct varicoceles by performing a surgical procedure called varicocelectomy.


The Male Infertility Best Practice Policy Committee of the American Urological Association recommends that varicocele treatment should be offered to the male partner of a couple attempting to conceive when all of the following are present

• A varicocele can be felt..
• The couple has documented infertility.
• The female has normal fertility or potentially correctable infertility.
• The male partner has one or more abnormal semen parameters or sperm function test results.

In addition, adult men whose varicocele can be felt and semen analyses show abnormal findings but are not currently attempting to conceive should also be offered varicocele repair.

A varicocele is the most correctable factor in a male with poor semen quality; therefore, varicocele repair should be considered a viable option for individuals and couples with otherwise unexplained infertility because varicocele repair has been shown to improve semen parameters in most men and possibly improve fertility.