HOW DO YOU FIX A VARICOCELE?
What Is Varicocele?
A varicocele is an enlargement of the veins, called the pampiniform plexus, within the loose bag of skin that holds your testicles (scrotum). These veins are like varicose veins (twisted, swollen veins, found in the leg.) Varicoceles form during puberty. They can grow larger like a lump and you may notice them more over time. Varicoceles are more common on the left side of the scrotum, most likely because of the position of the left testicular vein. Varicoceles can exist on both sides at the same time, but this is rare. About 10 to 15 boys out of 100 have a varicocele. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to fail to develop normally or shrink. Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and many don’t need treatment. If a varicocele causes symptoms, it often can be repaired surgically.
You may have no symptoms associated with a varicocele. However, you might experience:
- a lump in one of your testicles
- swelling in your scrotum
- visibly enlarged or twisted veins in your scrotum, which are often described as looking like a bag of worms
- dull, recurring pain in your scrotum
The size of the lump in your testicle helps your doctor classify your varicocele on a grading scale. There are three grades of varicocele:
- Grade 1: The smallest type, this is not visible, but a physician can feel it if they use a Valsalva maneuver.
- Grade 2: This is not visible, but it can be felt without a Valsalva maneuver.
- Grade 3: The varicocele is visible.
Varicoceles can be classified as:
- Pressure type: The spermatic vein fills up with blood, giving rise to a grade I varicocele.
- Shunt type: A severe buildup causes damage to the spermatic vein and other veins, leading to a larger, grade II or III varicocele.
Right-side varicoceles aren’t always a sign of a serious health problem, but they can be a sign that something is abnormal. Right-side varicoceles may suggest a blockage in your abdomen. These blockages can result from blood clots, tumors, or problems with your internal organs. In some cases, a right-side varicocele can be a sign of adrenocortical carcinoma. These cancerous tumors affect the adrenal glands located above your kidneys. Fortunately, these tumors are rare.
What Is The Main Cause Of Varicocele?
Doctors aren’t sure what causes this condition. It could be a problem with blood flow in the spermatic cord, which carries blood to and from your testicles. If valves inside the veins in the cord don’t work as they should, the blood backs up and the veins get wider. Each testicle has a spermatic cord holding it up. The spermatic cord has veins, arteries, and nerves. The veins have valves that keep blood flowing in one direction — toward the heart. If a valve in the spermatic cord doesn’t close the way it should, blood backs up and causes a varicocele. When varicoceles happen in teen boys, it’s often because of the quick growth they undergo during puberty. The testicles need more blood than normal as they develop, and any kind of problem in the veins can keep the blood from getting where it needs to go. The poor circulation caused by the varicocele results in a higher blood temperature, raising the temperature of the testes, which can serve as a barrier to sperm production and damage or destroy sperm that is created.
The varicocele can be identified on a routine physical exam when the testicles are felt while the male is in a standing position. Smaller varicoceles often are detected only on further testing, which can involve Doppler ultrasonography (ultrasound designed to detect the sound of backflow of the blood through the valve) and thermography (infrared sensing technology to detect pockets of heat created by the pooled blood).
The spermatic cord holds the vas deferens and the testicular artery, which brings blood to the testicle. It also houses the pampiniform plexus, a group of veins that drains the blood from the testicles. Testes need a certain body heat that is below our core body heat for optimal sperm production, maturity, and function. The body heat in the scrotum is about five degrees lower than that of the belly or pelvis. The latter is due to the presence of pampiniform plexus, which acts as a countercurrent heat exchanger, cooling blood in the testicular artery before it enters the testicles. This helps keep it at the body heat needed to make good quality sperms. When these veins become enlarged such as in varicocele, overheating of the testes can lower sperm production and function leading to lower fertility potential.
It has also been demonstrated that men with a familial history of varicoceles, especially in first-degree relatives, have an increased risk of disease occurrence [17, 18], indicating that the genetic factors may play an important role in the disease development.
What Happens If Varicocele Is Left Untreated?
Often, varicoceles are not treated. Treatment is offered for males who have:
- fertility problems (problems fathering a child)
- the left testicle growing more slowly than the right
- Abnormal semen analysis
If you don’t seek treatment for your varicocele when it is serious, it can lead to various complications:
- Testicular Atrophy: Varicocele can damage the affected testicle. A varicocele can lead to testicular atrophy or shrinkage. Sperm-producing tubules make up the bulk of the testicle. If they are damaged, the testicle might become smaller and softer.
- Infertility: It is another strong possibility for those who don’t get varicocele treatment. Untreated varicoceles of large veins can cause overheating. That, in turn, affects the number, mobility, and quality of the sperm. Men who are infertile and diagnosed with varicoceles often have low testosterone levels, too. Clinical evidence supports the theory that this is due to impairment of the cells that produce testosterone known as Leydig cells. Men who do get varicoceles treatment see an increase in their testosterone levels as a result because these Leydig cells begin to function properly once again.
- Hormonal Imbalance: Varicocele can also lead to hormonal imbalance. As the cells react to the increase in pressure, a change in hormones can result. There may be higher levels of luteinizing hormone (LH). This hormone is present in both men and women, but it is higher in women. There may also be normal-to-subnormal levels of testosterone.
How Long Does Varicocele Last?
Once a varicocele is present, it will not go away on its own. One can go for the various treatment options available as it will help in improving the condition.
What is the Best Treatment for Varicocele?
There are no drugs to treat or prevent varicoceles. But pain killers (such as acetaminophen or ibuprofen) may help with pain. If a varicocele is not serious enough for surgery, wearing supportive underwear may help reduce any pain. When needed, surgery is the main form of treatment. Embolization (briefly blocking the veins) is a non-surgical treatment option.
There are many ways to do varicocele surgery. All involve blocking the blood flow in the pampiniform plexus veins. Surgery is done under general anesthesia. The two surgical approaches used most commonly are:
- Microscopic varicocelectomy: With this technique, the surgeon makes a 1 cm incision above the scrotum. Using the microscope, the surgeon ligates all small veins and spares the vas deferens, testicular arteries, and lymphatic drainage. The procedure takes 2 to 3 hours to complete and the patient is discharged home on the same day.
- Laparoscopic varicocelectomy: With this technique, the surgeon inserts thin tubes in the abdomen and performs vein ligation. Because there are fewer veins to ligate in the abdomen the procedure is shorter and takes approximately 30-40 minutes to complete. The patient is discharged home on the same day.
Since surgeons have started using smaller cuts through the muscle for open surgery, healing time and pain are about the same with microscopic and laparoscopic surgery. Problems after either surgery are rare. Some problems are:
- varicocele remaining (persistence) or coming back (recurrence)
- fluid forming around the testicle (hydrocele)
- injury to the testicular artery
There is a small chance surgery won’t correct the problem. In rare cases, injury to the testicular artery can lead to loss of the testicle. Persistence or recurrence of the varicocele happens in less than one of ten patients who have surgery. Microscopic surgery has the lowest persistence rate or chance of varicocele coming back. Most of the time, patients return to normal activities after 1 week with little pain.
Is Varicocele Curable Without Surgery?
Here are few varicocele natural treatment.
- Change Your Diet: There is increasing evidence that foods containing white flour, sugar, and processed foods may be contributing to the formation of varicoceles. Increasing your intake of high-fiber and foods such as fresh vegetables, fruits, and whole grains into your diet may be helpful since these flavonoid-rich foods are known to enhance the structural integrity of blood vessels. Naturalists claim a lack of fiber often results in straining during bowel movements. This straining contributes to varicose veins, so remedying a bowel issue may presumably help with scrotal vein issues.
- Herbal Medicine: Using herbal therapy requires a consultation with a naturopath or holistic health practitioner before beginning a regimen. Taking herbs arbitrarily or self-prescribing can be dangerous
- Kegel Exercises: Some believe that Kegel exercises can help in alleviating the symptoms of varicocele. These are easy-to-do pelvic exercises that, when done consistently, can improve and restore muscle tone and blood flow. They are thought to relieve issues like incontinence and varicoceles.
It is a non-surgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild IV sedation and local anesthesia, patients are relaxed and pain-free during the approximately two-hour procedure. It involves a small nick to the skin, typically in the groin or neck. An interventional radiologist inserts a small catheter through this nick and advances it into the dysfunctional veins. Once the catheter is in the desired vein, it is used to insert small metal coils into the vein. In some cases, a sclerosant (an injectable irritant that contributes to the closing off of the vein) is used in conjunction with the coils and contributes to blocking the blood flow through the selected vein.
The advantages of varicocele embolization include:
- Outpatient procedure
- No general anesthesia, typically done with mild sedation
- 1 – 2 day recovery period
- 2-week recovery period before return to sexual activities
- 90 percent long-term success rate[vi]
- Potentially improved pregnancy rates
- It is considered the best alternative to those with a reoccurrence
- Minimal risk of infection
- No scarring
Varicocele is a health condition that can lead to problems like infertility and other issues. However, with constant vigilance and treatment, the condition can be improved and be under control. Hopefully, this article sheds some light on the condition.
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