Varicoceles describes a network of blood vessels that have become tangled, also known as varicose veins. Varicoceles usually appear on the left side of the scrotum and are frequently the cause of male infertility.
Causes and Risk Factors of Varicoceles
Blood flows to the testicles from an artery, then through a network of tiny veins, which then drain into a long vein that goes up through the abdomen. Blood flow in this vein should always be upward, toward the heart. A series of one-way valves in this vein prevent the blood from flowing back to the testicles. When these one-way valves malfunction, the reverse flow of blood causes the small veins around the testicle to stretch and form tangles.
Symptoms of Varicoceles
Because varicoceles develop over time, there may be no discernable symptoms. Generally varicoceles appear in men between the ages of 15 and 25, although an older man may experience them as a result of a kidney tumor, which can block the flow of blood to a vein.
When symptoms are noticeable, they usually include visible, enlarged or twisted veins in the scrotum, infertility problems due to an increase in temperature of the testicles that affects sperm production, and/or a testicular lump, swelling or a bulge in the scrotum.
A varicocele may be detected during a physical exam. If large, the scrotum can appear lumpy. If not physically apparent, abnormal blood flow can be diagnosed with a color flow ultrasound, an imaging exam or with a venogram - an X-ray that uses a contrast agent (special dye) that makes blood vessel abnormalities visible. Also, one testicle, the one on the side of the varicocele, may be smaller than the other testicle.
In some cases, support apparel, such as a scrotal support (jock strap) or close fitting underwear can help varicocele. However, if pain continues, corrective varicocele surgery (a varicocelectomy) may be recommended. Generally done on an out-patient basis and under general anesthesia, a cut is usually made in the lower abdomen, and the abnormal veins tied off, allowing blood to flow around the area, into normal veins.
In some cases, a varicocele embolization is recommended. Done on an outpatient basis, embolization is performed under "twilight" sedation, as opposed to general anesthesia. Varicocele embolization also requires a "nick" in the skin rather than an actual incision. This difference reduces healing time. A catheter (a small, hollow tube) is inserted into a vein in the groin or neck. With X-rays as a guide, the catheter is guided into the varicocele. A small coil is inserted through the catheter into the varicocele. The coil blocks the flow of blood to the damaged vein, rerouting it to normal veins.
Varicocele embolization has become the most favored treatment for varicocele because embolization is as effective as a varicocelectomy, but without the need for an incision or general anesthesia. Furthermore, recovery time and complications tend to be less with an embolization.