VARICOCELE
The veins in your testes (like those in the legs) have valves that help blood to flow upwards towards your heart. If your valves stop working, blood pools in the veins, which buldge or dilate, this is called varicoceles.
Who usually gets a varicocele?
It is usually first noticed in males between puberty and the age of 35, especially in late adolescence. About 15% of all men have varicocele. For many it is not a problem and does not require treatment. But nearly 40% of men who have fertility problems have a varicocele. If it is associated with infertility, it may need to be treated.
Who do varicocele cause fertility problems?
Varicoceles raise the temperature in the testicles, which may affect the production of sperm, as well as sperm movement and/or shape. It may also affect other aspects of sperm function. However, it is unknown by what mechanism varicoceles may impair fertility.
What are the symptoms and signs?
The patient is usually aware of a lump, especially when standing, but it disappears when lying down. The lump may have a bluish appearance through the skin; it is soft to feel, like a bunch of grapes or a “bag of worms”.
Degree of discomfort or pain varies considerably from one person to another, with others experiencing no form of discomfort while others experience a dragging pain, especially in hot weather or after exercise.
What is the risk?
A primary varicocele is basically a relatively minor problem without serious consequences. However, in some men the discomfort is such that a surgical treatment is required – others can live with a very mild discomfort.
What are the treatment options?
No treatment is necessary for a varicocele that is not causing any discomfort.
For mild discomfort and swelling, the patient can wear firm-fitting underpants or a jockstrap. Keep in mind that the discomfort and swelling tends to disappear when lying down.
There is no medication proven to treat varicocele hence when treatment is necessary, surgical management is employed.
Surgical treatment?
Surgery is recommended if the varicocele is causing significant discomfort, or is associated with a reduced size of the testicle or with infertility.
It must be noted that varicocele may recur after surgical treatment, and that in the case of infertility there is no guarantee that it will improve a man’s chance of fathering a child.
Types of surgery?
Your specialist urologist will decide on the method to treat the varicocele after discussing them with you.
The urologist may choose an operation to tie off the swollen veins and get rid of a varicocele, or any operation to block the swollen veins.
What are the risk of surgery?
Risk to a specific type of surgery include building up of fluid in the scrotum (hydrocele) and damage to an artery.
Varicocele may return after treatment.
Risk to any surgery include infections, pain, allergic reaction to the anaesthetic used and prolonged hospital stay which on its own has complications.
What will happen if varicocele is not treated?
There is not much research available to speculate. Some men will experience discomfort or testicle shrink and others have no problems.
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