A varicocele is when the pampiniform plexus becomes enlarged. The pampiniform plexus is a network of veins located in the scrotum. These veins remove oxygen-depleted blood from the testicles. Between 10% and 15% of males experience varicocele. It is similar to a varicose vein in a leg.
Much like varicose veins, the veins in the pampiniform plexus network can become swollen and twisted. Varicoceles are more likely to develop during puberty. As they grow larger, you will start to notice them. They are usually on the scrotum's left side due to the anatomy of the male body.
For the most part, varicoceles are harmless. In small instances, they can cause pain or issues with fertility or affect the growth of one testicle.
Usually, there are no symptoms of having a varicocele. Varicoceles can be concerning for a variety of reasons. They can slow down the left testicle's growth during puberty and lead to infertility.
Four out of 10 men who experience fertility issues when trying for their first child may struggle as a result of varicoceles. Eight out of 10 who experience issues with conceiving their second child or more were also affected by varicoceles.
There are a few reasons why varicoceles happen. It may be that the valves of the veins are not working properly, or they are missing. When blood moves too slowly, it can cause pooling within the veins. When blood pools in the veins, they can swell. Swollen lymph nodes may also block blood flow. This can cause scrotal veins to swell.
You can do a self-exam at home. During a doctor's appointment, your doctor may also examine the scrotum. Varicoceles usually look and feel like a "bag of worms." Your urologist will usually do the exam while you are standing up. During the exam, you will be asked to inhale deeply, hold it, and then bear down as your urologist feels the top of your testicles for enlarged veins.
If your urologist finds something during the exam, you may have to have an ultrasound of your scrotum. The sound waves from the ultrasound will create a picture of the inside of your scrotum. The ultrasound will show the size of the veins. It will also show the size of the testicles. Once an ultrasound is done, a treatment plan can be developed by your urologist.
Intervention is typically not done for varicoceles. Treatment is only considered for males who have issues with fertility. If one testicle is growing at a much slower pace than the other one, you can also seek treatment. Abnormal semen analysis may be another reason for treatment.
One form of surgery is microscopic varicocelectomy. During this surgery, your surgeon will cut an incision above the scrotum of 1 centimeter. All the small veins are tied up. The surgery is a two- to three-hour procedure. After this procedure, you can be discharged the same day.
The second surgery available is laparoscopic varicocelectomy. During this surgery, thin tubes are inserted into the abdomen to ligate veins. This procedure only takes 30 to 40 minutes as there are fewer veins in the abdomen. You can be discharged from the hospital the same day.
You can generally resume your normal activities one week after the surgery. You should experience only a little bit of pain.
There usually are not any problems after the surgery. One of the rare problems that can occur is the varicocele could come back. Less than 10% of patients experience the varicocele coming back, however. The microscopic surgery has the lowest chance of the varicocele returning.
Another problem that can occur after surgery is fluid may form around the testicle. The surgery could also injure the testicular artery. An injured testicular artery can cause you to lose the testicle.
Percutaneous embolization occurs when your interventional radiologist injects contrast through a tube in your neck or groin with the guidance of an X-ray to figure out what the problem is. The radiologist is locating the veins that lead to the varicocele. The doctor will then use coils to stop blood from flowing to the varicocele. Afterward, they are scarred down. Local anesthesia or light sedation is used during the embolization. The procedure is between 45 minutes and an hour long.
A few issues can occur after the surgery. The varicocele could come back. A coil could move. An infection can develop where the tube is. After the surgery, exercise should be avoided for 10 to 14 days. If you are doing embolization for fertility issues, you should have a semen analysis three or four months after. You should experience only mild pain during the healing process.
Varicoceles, for the most part, are harmless. However, occasionally, they can cause issues. At the Georgia Vascular Institute, we can address those issues either through surgery or a noninvasive embolization. Contact us today to book your appointment.