Varicocele

What is a varicocele?

Varicocele occurs when the veins in the scrotum are enlarged. A scrotum is a bag of skin that covers the testicles. These veins are known as pampiniform plexus. A varicocele is quite similar to varicose veins that form in the legs.

Varicoceles are common in males between 15 to 25 years. About 15% of adult males suffer from this condition. Varicoceles generally develop during puberty and occur mostly at the left side of the scrotum. Varicoceles on both sides are very rare. Sometimes, varicoceles can affect sperm quality and reduce sperm production. It can shrink testicles and cause infertility.

Most varicoceles are harmless and asymptomatic and do not need treatments. But sometimes they can cause pain, discomfort, and infertility and patients may need surgery.

What causes varicoceles?

The spermatic cord in males holds the arteries, nerves, veins, and tubes. It holds the testicles and supplies blood to and from the testicles. The scrotum veins (pampiniform plexus) carry the blood to the heart and the valves in the blood vessels prevent the blood to flow backward. The valves regulate blood circulation and prevent blood from flowing in the wrong direction.

Sometimes, the valves stop working properly. As a result, the blood flows backward and collects in the veins. Slowly, the veins stretch and get enlarged. This causes varicocele.

Who gets varicoceles?

Varicoceles can occur at any age. Some health experts believe that varicoceles are congenital. Varicoceles are more common during puberty or the teenage years when the blood flow increases in the genitals. Varicoceles in teenagers can affect testicular growth.

Diagnosis for varicocele

A physical exam is conducted to check your varicocele. If the mass is large, the doctor can feel it easily. If it is small, the doctor will ask you to do a Valsalva maneuver. This is a technique where the patient holds his breath for some time. It helps the doctor to detect the varicocele.

For inconclusive examination, the doctor conducts a scrotal ultrasound. The doctor takes the images of the spermatic veins to rule out other causes for varicoceles like tumors.

Treatment options

Treatment is mainly done for:

• Pain and discomfort.
• Testicular atrophy (shrinking of the testicles).
• Infertility.
• Azoospermia (complete lack of motile sperms in the semen)
• Boost self-confidence.

People also consider treatment to assist other treatments for infertility, testicular functioning, or to increase sperm production.

For swelling and pain, doctors may prescribe anti-inflammatory medications. Wearing a jack strap or tight underwear can provide support and alleviate the pain.

If the pain persists or the symptoms get worse, additional treatment like varicocelectomy or varicocele embolization is recommended.

Preparation

Preparation involves:

• Inform your doctor about over-the-counter medications, herbal supplements, vitamins, non-steroidal anti-inflammatory drugs (NSAIDs), and blood thinners like aspirin, etc.
• Follow instructions regarding prescription medications.
• Do not drink or eat 12 hours prior to surgery. It increases the risk of vomiting during general anesthesia.
• Bathe before the operation.
• Arrange for transportation after the procedure. Ask someone to accompany you after the procedure.
• Ask the doctor about aftercare instructions.
• Do not hesitate to ask the healthcare provider about queries regarding the surgery.

Procedures

Before the procedure, a healthcare provider will take your:

• Vital signs.
• Blood tests include ABG (arterial blood gases) and CMP (comprehensive metabolic panel).
• Other hormone tests include FSH (follicle-stimulating hormone) and semen analysis to detect any testicular dysfunction.
• ECG (electrocardiogram).
• Pulse oximetry will be placed to monitor your oxygen levels.
• An IV (intravenous) line is placed in the vein.
• The surgical area will be shaved and cleaned with an antimicrobial solution.
• The anesthetist uses regional or general anesthesia.
• After the patient is prepped, he will be wheeled to the operating room.
• Patient lies in a supine position.

During the procedures

Microscopic varicocelectomy

The urologist makes a 3-5 cm cut above the inguinal canal. This gives access to the pampiniform plexus. The spermatic cord is opened to access the spermatic veins. The urologist ligates the vessel using a microscope and other surgical devices. This diverts the blood flow and the surgeon closes the wound site.

Laparoscopic varicocelectomy

In laparoscopic varicocelectomy, the surgeon makes three key-hole incisions (1-1.5 cm) in the lower abdomen. The laparoscope, forceps, retractors, and other surgical devices are inserted through these incisions. The surgeon uses carbon dioxide to slightly inflate the abdomen and approaches the inguinal canal. The surgeon ligates the abnormal veins with sutures and clams. The incision site is stitched and adhesive strips or tissue glue.

Percutaneous embolization

The surgeon inserts a catheter through the leg’s femoral vein or the jugular vein present in the neck. Through the catheter, a contrast dye is administered. Fluoroscopy x-ray imaging shows real-time images of the procedure. Here, instead of ligation, the surgeon scars the affected veins or uses a chemical agent to block them. After the redirection of the blood flow, the catheter is removed, and the incision site is closed with adhesive strips.

After the surgery:

The patient is wheeled to the recovery room where he will rest. He will stay there until he is fully awake and his vital signs are normal. Feeling drowsy, nauseated, and fatigued is normal. There may be slight pain in the incision site. If the symptoms are severe, the healthcare provider will give some medications for relief. Once the patient is ready to walk, he can go home. The nurse or someone from the surgery team will instruct him about post-operative care.

Do patients have to stay in the hospital after surgery?

No, varicocele surgery is an outpatient procedure. Patients go home after some rest. A hospital stay is not required unless the patient develops some serious complications.

How long does recovery take after varicocele surgery?

Recovery depends on the type of procedure. Typically, for open surgery, it is 3-6 weeks. For laparoscopic surgery, it is 2-4 weeks and for percutaneous embolization, it is 1 or 2 days.

When should you go for varicocele treatment?

Sometimes, varicoceles produce no symptoms. But some people may experience:

• Scrotum swelling.
• The veins in the scrotum are twisted.
• Recurrent dull pain.
• Discomfort.
• Heaviness in the scrotum.
• Exertion increases pain.
• The pain progresses gradually.
• Lump in the scrotum.
• Infertility.

Surgery options

Varicocele surgery is an outpatient procedure. There is no need for hospitalization unless the patient develops serious complications. The procedure can be done in an outpatient surgical facility or a hospital.

Small clinics

Pros

• Low cost of the procedure.
• Less waiting time for consultations.
• Undivided attention from medical staff.

Cons

• Limited access to high-end surgical equipment.
• A small team may not be equipped to handle critical patients.

Big hospitals

Pros

• A large pool of medical experts.
• Multiple facilities in one hospital.
• Low complication rates.

Cons

• High cost of procedures.
• Lack of personalized care due to a high density of patients.

Cost of surgery

The cost of varicocele surgery depends on:

• The symptoms.
• The overall health of the patient.
• Type of surgery.
• Hospital charges.
• Surgical team charges.
• Postoperative care.
• Hospital bed charges.

Post-op care and things to keep in mind

• Returning home, patients must lie down as much as possible for the first 24 hours.
• For pain and swelling, use a cold compress.
• Do not wet the wound.
• While showering use a soft towel to soak and clean the area.
• Do not rub the wound.
• Avoid lifting anything heavy for one week.
• It is best not to go cycling or jogging for the first 3 weeks.
• Patients can go for brisk walks to promote blood circulation.
• Eat fiber-rich foods to avoid constipation.
• Refrain from sexual activities until directed by a physician. Premature intercourse can rupture the blood vessels.
• Schedule a follow-up visit with your doctor to see your recovery. In the case of fertility treatment, your doctor will wait for a few months for sperm analysis.

Complications from varicocele surgery

Surgical risks may include:

• Hydrocele formation. Fluid accumulation around the scrotum due to disruption of lymph flow during the surgery. In rare cases, the hydrocele can get enlarged and rupture. Additional surgery is needed to treat the hydrocele.
• Surgery may damage the testicular artery and damage the testicles.
• Many patients develop anesthesia complications post-surgery.
• Testicular atrophy due to accidental testicular artery ligation during surgery.
• Abdominal pain.
• Swelling and infection on the wound site.
• Varicocele recurrence.

Is there any way to prevent varicoceles?

Varicoceles cannot be prevented by medications. Medications can only relieve the symptoms. There is also no way to know whether you are at risk for developing varicoceles. But certain lifestyle changes can improve blood circulation and prevent varicoceles.

• Regular exercises increase blood circulation and are good for artery health.
• Moderate exercises like brisk walking, swimming, and cycling are good for overall health.
• Foods like fish, avocados, nuts, etc., are rich in omega-3 fatty acids and reduce inflammation.
• Avoid processed foods, sugars, saturated fats, sodium, etc., that are bad for vein health.
• Drinking enough water flushes the toxins from the body and helps blood circulation. It prevents the blood to thicken.
• Abstain from smoking. It causes plaque formation in the arteries and blood vessels.

Best option

Varicocele surgery is a minimally-invasive procedure. Patients can go home after the procedure. Goficure provides all kinds of services in elective surgery. They provide a complete treatment package from consultation to postoperative care.

Reasons to choose goficure:

• One-stop solution for complete medical care.
• Expert doctors and surgeons.
• Quality healthcare at affordable prices.
• Hassle-free treatment.
• Full confidentiality of patients.
• Safe and reliable treatment.

References