Varicocele is a bunch of enlarged veins in a man’s scrotum that feels like a “bag of worms” on touch.
A varicocele is a relatively common condition in young men. One out of 10 men suffers from varicocele and occurs mostly on left side. Varicocele may be asymptomatic or may cause pain, swelling or sometimes infertility. It is the most common identified correctable cause of male infertility.
Why does a varicocele occur?
- Normally, testes get fresh oxygen rich blood via an artery and used blood flows out via a network of small veins, which is carried back to the heart. This flow is one-way and reverse flow is prevented by a series of valves in the veins. In some individuals, however, these valves do not work well and the blood flows in reverse direction. The veins become enlarged and form a varicocele.
- What are the symptoms?
- Commonly a varicocele is silent and does not cause symptoms. However, some varicoceles cause a dull or aching pain, especially when the person is standing for a long time. In some individuals, a varicocele may cause infertility. In some men, varicocele can cause shrinkage (atrophy) of the testicles and low testosterone levels.
- How is varicocele diagnosed?
- It is best to catch a varicocele before it causes major problems, such as infertility. Self-exam of the scrotum is an easy way to diagnose a varicocele. A varicocele can feel like a "bag of worms". USG Doppler confirms the diagnosis.
- What is the treatment?
- For men who are having mild or occasional symptoms, the following steps may be enough to control the discomfort:
- Wearing a jockstrap (tight underwear),
- Avoiding heavy weight lifting.
- If these measures do not help, the varicocele can be treated with embolization or surgery. Studies have shown that embolization and surgery are equally effective.
- How does Embolization work?
- Embolisation procedure is done without any surgery, cuts and stitches. It relieves pain and swelling and may improve sperm quality for infertile couples.A small catheter (thin plastic tube) is inserted into a leg vein near the hip or neck vein. X-ray is done to confirm the catheter position. Then, tiny coils made of platinum, or glue is injected in the vein. They block the reverse flow in the varicocele. Blood can still exit the testicle through other normal veins. It is done as a day care procedure under local anaesthesia. The patients can be discharged after few hours of observation. This method is least invasive, very safe and has high success rates.
- What is the success rate?
- There is a 90 percent success rate with embolization. Its safety and effectiveness has been shown in very large studies.
- Are there any complications associated with varicocele embolization?
- The complications are rare, which may mild pain for few days, irritation or burning sensation.
- What is Varicocele Surgery?
- Several surgical approaches can be used to close off the faulty veins to correct the varicocele. These include open surgery, microsurgery and laparoscopic surgery.
- Are there any complications of surgery?
- Varicocele surgery presents relatively few risks, which might include: Accumulation of fluid around the testicles (hydrocele), Shrinking of the testicle on the side of the surgery due to inadvertent damage to artery (reported in less than 1%) or Failure to relieve pain
- What is best for me?
- You should discuss your treatment options with your doctor. Some questions to ask include:
- What are the risks and benefits of Surgery and Embolisation?
- Is varicocele embolization an option for me?
- How many days do I need to miss the work or office?
For more info please contact Dr Shahnawaz B Kaloo (Max Hospital Saket New Delhi) at: doctor.kaloo@gmail.com