12 April 2021 Author : Bruno Graça What is varicocele? Varicocele is a swelling due to the varicose dilation of the veins that drain blood from the testicles . In most cases - about 90% - varicocele occurs on the left side because venous blood column is bulkier and drainage of venous blood is more difficult in the left spermatic cord. The spermatic cord runs through the inguinal canal, from the abdominal cavity to the testicles, and includes arteries, veins, lymphatic vessels, nerves, and the vas deferens . Varicocele is a benign disease. It usually has no damage to health. However, in the most severe cases, it can lead to delayed testicular growth with changes in spermatogenesis and hormonal production. In the infertile male population, varicocele represents 25% -40% of cases , thus constituting one of the main causes of male infertility. Who has varicocele? Varicocele appears at puberty , when the volume of the testicles increases, and secondary sexual characteristics develop with the highest testosterone production. It has an incidence of 15% -20% in the fertile young male population, with a peak between 15 and 25 years. Symptoms and diagnosis The signs and symptoms have a varying severity. The most common are: Swelling in the upper testicle, near the scrotum origin, which may worsen with exertion, exercise or at the end of the day. Slight testicular discomfort or pain, which typically does not exist in the morning (after rest), worsens on foot, and relieves with lying down. The increase in local temperature can interfere with the formation and quality of sperm. The diagnostic evaluation in medical consultation includes: Clinical history; Objective or physical examination; Scrotal ultrasound with Doppler, to document the venous dilation and to verify the venous reflux in the efforts. Tests for testicular function, such as testosterone and sperm count, can also be ordered to support clinical decision. Treatment of varicocele The treatment of varicocele can be surgical, by open or by laparoscopic surgery , or using embolization . However, treatment is not always indicated, especially when varicocele has no symptoms or predictable consequences for fertility. Thus, as a rule, the treatment of varicocele may be indicated in the following circumstances: Decreased testicle size (testicular atrophy); Affects both testicles (bilateral varicocele); Presence of symptoms; Changes in seminal parameters. The surgical approach and the embolization have different rates of efficacy and complications. Complications from varicocele treatment are very uncommon and can be hemorrhage, testicular pain, varicocele persistence or hydrocele formation (accumulation of fluid with increased scrotal volume). Open and microscopic surgery Open surgery is the most widely used in the treatment of varicocele . The operation is done through a small 3-4 cm incision in the abdomen. The success rate of block ligation of the spermatic pedicle is about 98% and the risk of hydrocele is about 7%. The success rate of microscopic inguinal ligation is 97%-99% and the risk of hydrocele <1%. However, it takes longer, and a suitable microscope is needed. Laparoscopic surgery Laparoscopic surgery is usually reserved for bilateral varicoceles . It is slightly longer than open surgery and has a similar success rate. Embolization Surgical embolization under radioscopic control has a success rate of 75%-90% and the risk of hydrocele, which is the main complication of varicocele treatment, is practically zero. Meet the urology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
