Varicocele is a dilation (widening) of the veins along the spermatic cord (cord that suspends the testicle) in the scrotum. This dilation occurs when the valves in the veins along the spermatic cord fail and cause retrograde outflow of blood flow, causing blood to accumulate.
The mechanisms by which varicocele might affect fertility have not yet been explained, as have the mechanisms by which surgical treatment of a varicocele might restore fertility. One study analyzed 10 studies (894 participants) and found evidence (the combined odds' ratio was 1.47 (95% CI 1.05 to 2.05) to suggest an increase in pregnancy rates after treatment varicocele compared with no treatment in subfertile couples, of which, apart from poor semen quality, male varicocele was the only abnormal finding.
This means that 17 men would need to undergo treatment to achieve an additional pregnancy. However, these results were not conclusive because the quality of the available evidence was poor and further research will be needed and will need to look at the rate of pregnancy or live birth as the primary outcome.
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What are the causes of varicocele?
Varicocele is caused due to the dysfunction of a valve located in the veins (which allows blood to flow to the testes). As the cause of this dysfunction is still unknown , it is impossible to explain the exact causes of varicocele.
What are the symptoms of varicocele?
Varicocele can either not give any symptoms (and in this case it remains undetectable), or manifest itself by the following symptoms:
- A heaviness in the testicles , especially at the end of the day or in hot weather;
- At an advanced stage, an increase in the size of the testicle.
Varicocele: what diagnosis?
Bilateral and comparative, the diagnosis looks for varicose dilations above the testes. The palpation of the testes is normal. The examination eliminates another cause of heaviness ( inguinal hernia , cyst of the spermatic cord, effusion of fluid in the bursa, tumor of the testis ).
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Varicocele: additional examinations and analyzes
They are irrelevant when the clinical examination is formal . If in doubt, an ultrasound is performed . It highlights venous dilations, eliminates another local pathology and may, if a doppel study is associated , show stagnation of blood in dilated veins.
The varicocele operation is performed to remove the varicose dilation produced in testicular veins . These varicose veins cause problems with the functioning of the testes and can affect a man's fertility .
It usually affects the left testicle (87%). In 7% of cases it affects both testicles and in only 3% of cases it affects the right side.
This operation is recommended for the following patients:
- Man who is looking for offspring and who has a varicocele and alterations in the analysis of semen.
- Young men with alterations in semen analysis or a decrease in testicular size .
- Adolescents with varicocele who have a smaller testis homolateral to the varicocele.
- Men of all ages with varicocele and testicular pain on the same side.
Varicocele cure is surgery that aims to sclerosis or ligate the dilated spermatic veins.
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The evolution of varicocele
The course is variable: a varicocele may very well never bother the patient . Conversely, it can cause discomfort which increases over the years to become almost permanent. Sometimes varicocele is only bothersome in periods.
Can Varicocele Affect Fertility?
While no study has confirmed the link between varicocele and infertility, some figures suggest that there may be an incidence: in fact, 40% of infertile men have varicocele, compared to 15% of men in the general population. During the infertility assessment in men, the doctor systematically performs a clinical examination of the genitals in particular to detect a possible varicocele.
Varicocele: what complications?
In addition to the other pathologies of the cord and the testicle (see above), it is necessary to think in an adult of more than 30 years of the possibility of a tumor of the kidney . Indeed, the bulky masses of the kidney can cause compression of the renal vein, or even of the inferior vena cava, and decrease the venous return of the spermatic veins. A varicocele can therefore, exceptionally , lead to the discovery of kidney cancer .
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Treatment of varicocele
It depends on the discomfort felt: unhindered patients do not have to be treated, except in cases of associated infertility because the treatment of varicoceles allows in some cases the return to fertility.
The treatment can be:
- Surgical : it is performed either by a classic incision (inguinal or abdominal), or by laparoscopy (a camera is introduced through a reduced incision in the abdomen). It consists in ligating the spermatic veins in their upper part, to cause an involution (regressive modification) of the veins of the cord;
- By embolization : the embolization technique is performed under local anesthesia . A small catheter is introduced through the femoral artery to the dilated spermatic veins, through which substances are injected to block the vein . The disappearance of the varicocele at 3 months is obtained in 98% of cases. This minimally invasive technique is as effective as surgical treatment.
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