They do not cause cancer and are not life threatening, but are simply an anatomic consequence of being human. To learn more about varicoceles and treatment options, including surgery, please select one of the following topics. If you are ready to schedule a consultation, please request a consultation here. Most varicoceles are asymptomatic. However, they can be uncomfortable and cause scrotal pain. This pain is generally mild to moderate, occurs with long periods of sitting, standing or activity and is relieved by lying down.
The mechanism by which a varicocele on one side can affect the fertility of both testicles is not clearly understood. What is true is that the temperature of the scrotum is normally several degrees cooler than body temperature, which is important for normal sperm production and testis function.
This temperature difference is carefully maintained by the normal anatomy of the scrotum. Exactly how heat affects sperm production is currently the subject of much male fertility research. However, a leading theory suggests that increased oxidative stress reduces the fertility of varicocele patients.
In addition, there is recent data that shows that sperm DNA fragmentation rates, a measure of sperm quality, can be elevated in men with varicoceles and that varicocele repair can significantly lower these rates. In any case, the semen analysis in varicocele patients can show impaired sperm numbers, movement or both. With a patient in a standing position, palpation of the scrotum by a well-trained physician can reveal a varicocele. Exercise and prolonged standing may also demonstrate a varicocele.
Difficulties palpating a varicocele arise when the scrotal wall is thick or contracted. In addition, benign fat, termed lipoma of the cord, can feel like a variocele. Unlike a varicocelehowever, a lipoma will not go away when the patient lies down. Subclinical varicoceles are lesions not detected by routine examination, but are suggested by radiologic or other imaging methods.
It is these lesions that are repaired for issues of discomfort or infertility.
The diagnosis of varicocele can also be made with venographyultrasound, thermography, scintigraphy and CAT scan or magnetic resonance imaging. Venography is considered to be the best diagnostic test, but it is invasive, involving catheterization of large leg veins to access this system.
Conveniently, venography can be combined with embolization using balloons or coils to treat varicoceles at the same time.
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Doppler ultrasound is less invasive than, and correlates well with, venography and relies on the detection of venous flow within the varicocele.
This is the test that Dr. Turek prefers to have patients do if there is a question about whether or not a patient has varicoceles. Thermography, scintography and MRI or CAT scans are of limited clinical use for varicocele mostly because of increased costand lack of controlled studies surrounding their use.
To achieve this, veins leading from the testis to the body are tied off or interrupted as completely as possible.
A single vein is left open vasal vein that is not subject to the same issues as the varicose veins and allows the blood to leave the testicle after surgery. There are several ways to treat varicoceles. Surgical or incisional methods are performed in the upper scrotum subinguinalgroin area inguinal or lower abdomen retroperitoneal. From: Zenke U and Turek PJ.
Edited by Patton and Battaglia. Humana Press, Totowa NJ. This is especially true for varicoceles on both sides. The spermatic cord is exposed and inspected on either side for external cremasteric veins. If present, these veins are tied off with silk suture. The area around the testis is then inspected for the presence of any exiting veins and these are tied. The operating microscope is brought into the field and the investing layers of the spermatic cord opened.
Microsurgical dissection of the cord is then performed: the artery is visually identified by its pulsations with the help of a small doppler ultrasound if necessary and all surrounding veins are tied. Lymphatic vessels are noted and spared to prevent hydrocele formation. At the end, only the vasal veins remain intact to provide venous return from the testis. The spermatic cord is then returned to its bed and the incision closed in two layers.
Steri-strips and a bandage are placed. It is best to return to work without the need to take narcotic pain pills, as they may cloud judgment. Read Varicocele Patient Instructions, Preparing for Varicocele Repair Surgery.
Complication rates must also be considered in any decision to have varicoceles treated. The most significant complication with radiologic occlusion is the chance that the culprit veins cannot be accessed or interrupted technical failure rate. Although the list of potential complications is long, remember that the chance of having a complication is really quite low.
Turek has studied this issue at length and has written and published extensively on this topic. So, cost-benefit studies convincingly demonstrate the value of varicocelectomy instead of assisted reproduction. Turek has confirmed the value of varicocele as suggested by cost-benefit studies by using more sophisticated decision analysis modeling.
Decision models are constructed with predefined assumptions and serve as useful tools for estimating outcomes when multiple complex medical treatments are available. For his varicocele study, he assigned outcome probabilities based on his outcomes and published outcomes, and costs of interventions were calculated from his own cost data.
Sensitivity analyses were applied to determine which elements were most important for varicocele treatment.
Then, theoretical subjects were put into different levels of assisted reproduction IUI vs. IVF-ICSI based on their semen quality. Overall, varicocele surgery was found to be more cost effective than IVF.
Interestingly, there were some instances in which IUI was more cost-effective than varicocelectomy, depending on the presenting semen quality of the patient. Thus, the clinical characteristics that define the individual couple weigh heavily on whether assisted reproduction or varicocelectomy should be done. Taking a different analytical approach, Dr.
In essence, it appears to make good economic sense to repair varicoceles if ART costs are prohibitively expensive for couples.
He has operated on sultans and sailors, prime ministers and principals. In addition, many varicocele patients he sees have failed the procedure elsewhere.
Because of this experience, his complication rates are extremely low. View his complete CV Dr. Turek began performing the microscopic subinguinal varicocelectomy, a form of incisional treatment for varicoceles that is performed in an hour or so on a come-and-go basis. Performed with a light general anesthetic along with local anesthesia, this procedure allows visual access to all possible routes of venous return to the testis and accomplishes this task through a small, minimally painful, upper scrotal incision.
It avoids the need to open any muscular layers of the abdominal wall commonly needed for the other incisional approaches and dramatically shortens recovery time. Turek about Varicocele Treatment. Want to get some cool men’s health news once a week? Email This field is for validation purposes and should be left unchanged. Tour The Turek Clinic Los Angeles. Tour The Turek Clinic San Francisco.
Ejaculatory Duct Obstruction and Resection. They are generally acquired during puberty. Varicocele V is the blue set of veins that drain blood from the testis to the body.
Varicoceles and Male Fertility. Read about Varicocele Treatment Patient Instructions. Varicocele size and grading. Varicocele only palpable during or after Valsalva maneuver on physical exam. Varicocele palpable on routine physical exam without the need for Valsalva maneuver. Varicocele visible to the eye and palpable on physical exam. Surgery or Assisted Reproduction? A Decision Analysis of Treatment Costs in Male Infertility.
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