varicoceles
WHAT IS A VARICOCELE?
A varicocele is a varicose (dilated) vein of the testicle, which usually develops at puberty. It is not clear why they occur. The majority of varicoceles are found on the left side (90%).
HOW ARE VARICOCELES DIAGNOSED?
Varicoceles are MLB usually diagnosed on careful physical exam, usually by feeling a “bag of worms” above the testis, which becomes more prominent with straining, and gets smaller with laying down. Sometimes an ultrasound is necessary to diagnose a varicocele.
WHAT PROBLEMS DO VARICOCELES CAUSE?
It is estimated that 1 in 8 of all men have a varicocele, yet most never know it because they cause no problems. However, it is found more often in infertile men, and is reported to occur in 1 of 3 men who have fertility problems, and in 3 of 4 men who have fathered at least one child but are now having problems conceiving. Occasionally, varicoceles may cause pain, described as a dull ache that is made worse with standing for long periods of time.
HOW DO VARICOCELES CAUSE INFERTILITY PROBLEMS?
There are many theories on why varicoceles cause fertility problems, but the most accepted concept is that a varicocele raises the testis temperature and causes atrophy (shrinkage) of the sperm producing cells, thus impairing sperm production. The semen analysis may show abnormalities in sperm motion count and shape. The simultaneous occurrence of all three of these abnormalities has been termed a “stress pattern”, which may be seen in men with a varicocele, but is not diagnostic of it.
WHAT ABOUT CHILDREN WITH VARICOCELES?
A juvenile with a varicocele represents a complex management problem because not all varicoceles will cause problems. The goal is to prevent future fertility problems while avoiding unnecessary surgery. Early surgery may be beneficial, especially in boys with a smaller testicle on the side of the varicocele, because it has been shown that early correction of the varicocele may allow “catch-up” growth of the affected testis and improvement in sperm counts.
HOW ARE VARICOCELES REPAIRED?
Most commonly varicoceles are surgically corrected. The basic method involves tying off all the dilated veins about the testicle. The usual technique is done through an inguinal (groin) incision, which takes about 30 minutes and is done as an outpatient. It is recommended that men stay off their feet for two (2) days and don’t lift anything heavy (over 20 pounds) for two (2) weeks afterwards. Laparoscopic repair and percutaneous embolization are also effective, but usually offer no significant advantage over the inguinal approach. There are very few problems that occur after inguinal surgery: about 3% develop an infection, a hematoma (temporary blood clot in the scrotum), or hydrocele (a fluid-filled cyst around the testicle). Only about 2% of varicoceles recur after inguinal surgery.
HOW SUCCESSFUL IS VARICOCELE SURGERY?
Improvement in semen quality is seen in 50-90% of patients 3-6 months after surgery, with greater improvement following repair of larger varicoceles. Pregnancy rates after surgery typically approach 30-50%.