Definition & Overview

Varicoceles are abnormal swelling or enlargement of the veins, known as the pampiniform venous plexus in the scrotum. These veins are responsible for draining the testicles, and can be swollen when there are vein compressions or defective valves within or near the structures. The presence of a varicocele is identified to be one of the leading causes of infertility in men. This is because varicoceles cause a drop in the production and quality of the sperm. In younger patients, infertility is not the main concern, but rather, the failure of the testicles to develop normally.

Cause of Condition

The network of veins, arteries, tubes, and nerves connecting the testicles to the abdominal area is responsible for delivering blood to and from the testicles. Normally, the veins in the body carry the blood from different parts of the body back to the heart, and these veins are equipped with valves that ensure the blood flows one way and not backward to where it originated. When these valves fail to perform their task, the blood flows back to where it came from. The blood will then pool back into the vein, which is not meant to manage a higher amount of fluid. When the valves malfunction, the veins in the scrotum become stretched and swollen resulting to varicoceles.

Varicoceles typically develop over time, affecting mostly patients aged 15 to 25. Research shows that the exact cause of a varicocele formation is not clear, but there are several theories in the field. The first one is mentioned above, when the valves in the veins fail to function properly and causes the blood, which should be delivered to the heart, to flow back to its origin and thus cause the swelling of the veins. Many medical professionals also believe that anatomic asymmetries can also cause varicoceles—differences in the right and left spermatic veins, or an asymmetry, can increase the pressure on one side of the testicles.

The Nutcracker Effect, on the other hand, posits that the left renal vein, which starts from the side of the left kidney, becomes compressed or pinched. This then causes abnormal pressure in the left spermatic vein as it tries to deliver blood back into the patient’s heart.

Key Symptoms

Varicoceles can go undiagnosed for years, mostly because the symptoms are not very obvious to the patient. Many patients typically discover the condition in a routine physical check-up or a fertility exam.

However, one of the more common signs of varicoceles is a lump in one of the testicles, or abnormal swelling in the scrotum. Upon closer inspection, the veins in the scrotum might appear twisted or enlarged—many patients and physicians have reported varicoceles appearing like a “bag of worms” underneath the skin. The swelling of the veins can also be palpable—one can feel the swelling and twisting of the veins in the scrotum.

At times, varicoceles can cause pain within the scrotum or heaviness in the testicles. Shrinking of the patient’s testicles is also a common symptom, caused by the irregular blood flow in the scrotum. Abnormal levels of testosterone can also be experienced by the patient, as well as urinary problems such as benign prostatic hyperplasia.

Who to See and Types of Treatments Available

When you observe one of the symptoms described above, it is best to schedule an appointment with a doctor as soon as possible. In many cases, the varicocele can be easily observed by sight or touch—if the swelling is big enough, the doctor (typically a urologist) will not require specialized tests to confirm the presence of the varicoceles. However, if the swelling is smaller, the doctor will ask you to stand, inhale deeply and hold it down to see if there is an abnormal swelling or enlargement in the veins of the scrotum.

If the physical exam did not show the presence of an abnormal swelling in the scrotum, the doctor could then order a scrotal ultrasound. Further imaging procedures might be required to confirm the presence and extent of the varicocele, as well as guide the doctor in formulating the best treatment plan.

When the varicocele is diagnosed, there are several treatment options available. In some cases, a doctor might advise the patient to not do anything about it as long as it is proven that it is not harming the genitals and reproductive functions. But if the swelling in the scrotal veins is causing infertility, discomfort, pain, or shrinking of the testicles, it is best to undergo treatment for the condition.

Surgery is one of the most common treatment procedures for varicoceles. Surgical treatment aims to seal off the affected vein in the network to allow for normal and proper blood flow. Patients who are suffering from infertility because of the swelling of the scrotal veins can observe an improvement in their sperm count and quality. Open surgery, guided by Doppler ultrasound, remains popular for varicocele treatment. Laparoscopic surgery is also popular, where a small incision is made in the lower abdomen, and a tiny instrument is passed through it to view and treat the varicocele.

Another treatment method is percutaneous embolization, where a small tube is passed through a neck or groin vein. This tube is used with a tiny instrument where a solution or a coil is released to insert a “block” in the veins to prevent backward flow. Embolization is not as popular as surgical treatments, but more and more patients are opting for it (upon recommendation by their doctors) because it is non-surgical. Embolization requires less downtime and shorter recovery periods, and does not result in scarring in the scrotal area.

For less serious varicoceles, patients can take over-the-counter pain medication, such as ibuprofen and acetaminophen. Wearing an athletic supporter can also relieve the scrotal veins of the pressure.

References:

  • Varicoceles, American Urological Association Foundation
  • The Varicocele, Urologic Clinics of North America
  • Painless Scrotal Mass, The Merck Manual Professional Edition
  • Youth Varicocele and Varicocele Treatment, JJ Nork et al.
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