What is varicocele? Varicoceles is a disease related to veins of testis where these vein becomes abnormally large and tortuous due to blood pooling. Normally there are one way valves inside veins which allow only unidirectional blood flow from testis upward heart against gravity. Damage of these valves can lead to loss of unidirectional blood flow and blood start pooling inside testicular veins, especially during prolonged standing or prolonged sitting position. This pooling of blood lead to gradual dilatation followed by tortuosity of these testicular veins.
How does varicocele can affect our body? Early varicocele causes pain in scrotum, groin, flank and sometimes medial aspect of thigh during prolonged standing or sitting position. On long term, varicocele damages sperms and male hormone production inside testis. It leads o infertility and impotence. It is also one of reason for premature ejaculation. Varicocele is one of the most common causes of infertility in male.
What are symptoms of varicocele?·
- Pain and swelling of testis ,
- gradual reduction in size of testis
- Infertility due to sperm damage
- Impotence due to loss of male hormone
- Premature ejaculation
How varicocele is diagnosed? Early varicocele (grade 1) is diagnosed only on Doppler ultrasound examination. But Advance varicocele can be diagnosed even by clinical examination as these are visible on inspection or can be felt as “bag of worm” on palpation.
What is treatment of varicocele? Is there any effective medical treatment? There is no effective medical treatment yet to cure varicocele. Only surgery can cure it . Anti-inflammatory drug can be used as pain killer, Antioxidant medicines like vitamin E, Vitamin C, Lycopene, Coenzyme q and L-carnitine combinations are used to protect sperm from harmful substances which accumulate in testicular veins due to persistent blood stagnation.. Which surgery is best for varicocele? Microscopic Sub-inguinal Varicocelectomy is the best surgical option yet, having least complications and least risk of recurrence. In this surgery, a small incision is made just below inguinal crease where scrotum meets with penis (Peno- scrotal junction). Spermatic chord is mobilized outside through skin incision and examined under operating microscope. All visible dilated veins are ligated and divided. Microscope helps in identifying and distinguishing all abnormal vein from testicular artery and lymphatics clearly. Identifying and preserving testicular artery under magnified view of microscope helps in preserving fertility. Preserving lymphatic helps in avoiding hydrocele as a complication.
How long I have to stay in hospital after surgery ? When can I join my duty after surgery? Normally patient is discharged one day after surgery. Patients can walk even next day after surgery. Office job can be resumed within one week. But heavy work, weight lifting etc. are avoided up to three months post-surgery.
After how long I will regain normal sperm count? Although sperm production starts improving soon after surgery but on lab examination significant improvement will be visible only after three months. Sperm count and quality keep on improving till one year after surgery and can normalize too. If this is still not normal after one year, other possibility for abnormal spermatogenesis should be looked for. Patient who have very less sperm count prior to surgery ( < 5million/ml) may not significantly improve after varicocele surgery. Is there any side effect post-surgery? Mild hydrocele can occur and remain there for one or two months and usually resolve itself. Mild pain may persist after surgery which may last for three months and gradually subsides. Recurrence of varicocele can happen in 5 to10 % cases few months to few years after surgery and may require second surgery if symptoms persist. Risk of recurrence and other complication is least with microscopic surgery.