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Q. What is a varicocele?
A. A varicocele is mass of enlarged, twisted blood vessels that occur in the spermatic cord, a scrotal structure that comprises blood vessels, nerves and the duct responsible for transporting sperm from the testicles to the vas deferens. Like other blood vessels in the body, the blood vessels in the scrotum are lined with tiny valves that control the flow of blood. If these tiny valves malfunction, the flow of blood is disrupted, resulting in swelling and enlargement of the vessels.
In appearance and texture, the varicocele has been clinically likened to a bag of worms. Although the appearance may be alarming, some varicoceles are asymptomatic and do not require treatment. However, other individuals may experience feelings of pain, aching and heaviness in the area as a result of the varicocele, and in a few rare cases, atrophy may be evident.
A more common occurrence with varicocele is male infertility. Although the direct relationship between varicocele and male infertility has not been clearly defined, clinicians believe infertility occurs as blood circulation slows, allowing the sperm to become overheated in the spermatic cord, resulting in sperm death.
Q. Who is typically affected?
A. About 10 to 20 percent of all men develop a varicocele, with the condition developing most often around puberty. Some men may also develop a varicocele later in life, as a result of vascular disease.
Generally, a varicocele occurs when the tiny valves within the blood vessels malfunction, allowing blood to flow in multiple directions. These valves can malfunction as the result of several reasons, including congenital defects or conditions; trauma or injury; or pressure from surrounding organs and structures which can cause blood vessels to compress, placing additional pressure on the valves and causing them to malfunction.
The process involved in the development of a varicocele is very similar to that which occurs with varicose veins in other areas of the body. These bulging, twisted veins also occur as a result of malfunctioning valves within the vesselís internal structure.
Q. What are the treatment options?
A. Varicoceles can be treated through several approaches. The most common approach, and the method which has been used successfully for decades, is varicocelectomy. In this outpatient surgical procedure, your specialist will make a small incision in the groin or abdomen and remove the varicocele. The procedure takes about an hour to perform, and typically involves about a week of recovery time. Strenuous lifting and exercise will need to be avoided for an additional seven to 10 days.
Newer techniques, including embolization and laparoscopy, are less invasive. These techniques focus on preventing blood flow within the compromised vessels, either by creating an intentional obstruction or by tying off the varicocele. By preventing blood flow, the compromised vessel can eventually atrophy. Both embolization and laparoscopy are less invasive than varicocelectomy, and both are associated with only a few days of recovery time. However, these techniques are also associated with a higher risk of recurrence of the varicocele.
Each technique will require use of icepacks during the initial 24 hours following surgery to reduce swelling and improve healing. Patients may also be given a special support garment to wear during recovery and healing.
Q. What are the risks associated with treatment?
A. Generally speaking, the risks of varicocele treatment are the same as with any other type of surgery, and include potential infection, as well as bruising, swelling and discoloration. About 5 to 20 percent of men who receive treatment will experience a recurrence of varicocele, with embolization and laparoscopy generally associated with higher rates of recurrence. When varicocele does recur, embolization and laparoscopy are the technique most often sued to correct the recurrence.
Q. What is the link between varicocele and infertility?
A. Statistically, a significant portion of male infertility issues can be attributed to the presence of a varicocele. Although the actual link between the two has not been clearly defined, clinicians believe the compromised blood flow in the spermatic cord results in a rise in temperature which is sufficient to kill off sperm as they travel to the vas deferens. Indeed, studies have revealed large numbers of dead sperm in the ejaculate of men who suffer from varicoceles. For men who suffer from infertility as a result of varicocele, removal or other treatment of the varicocele is associated with high levels of success. Men who are treated for infertility should understand that it takes about three months after varicocele treatment for sperm levels to return to levels which are capable of fertilization.