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Varicocele : Symptoms, Causes and Treatment

Varicocele is a swelling of a vein in the scrotum. Varicocele occurs in the scrotum which functions to hold the testicles and contain arteries and veins in the spermatic cord on each testicle above the scrotum. The blood vessels that carry blood from the testicles to the penis should not be felt, but when there is a varicocele the veins look like many worms in the scrotum. This condition is similar to varicose veins in the legs.

Varicocele can form around the age of 15 to 25 years, and most are found in the left scrotum. However, varicoceles can still occur on both sides of the scrotum. Varicocele often causes no symptoms and does not endanger life, but can cause a decrease in the testes so that it can interfere with fertility. Varicocele causes that cause symptoms or causes infertility in patients, can be treated by surgery.

Varicocele Symptoms

Varicocele is often experienced without significant symptoms. In some cases, varicoceles can be accompanied by mild pain. In addition, symptoms that appear can include discomfort around the scrotum which increases when standing long. Complaints will slowly subside with lying down and resting.

Under certain conditions, the varicocele can affect sperm quality and production. Therefore infertility or fertility disorders are the main reason when patients are treated for the first time.

Causes of Varicocele

Most varicocele cases occur because the vein valve is not functioning properly. Along the veins, there is a one-way valve that opens blood flow to the heart and immediately closes when the blood flow slows down. Varicocele occurs when the valve cannot close properly so that the blood flow turns and collects in the area before the valve breaks, then forms a varicocele. However, it cannot be ascertained what causes the vein valve to not function properly.

Varicocele can also occur when larger blood vessels in the stomach are blocked, so that blood collects in small veins, like the scrotum, so that the blood vessels dilate. But this condition is more common in men over 40 years. This condition can be caused by a variety of conditions, for example, tumor growth in the kidneys that suppress veins.

Varicocele Diagnosis

The diagnosis of varicocele begins with a physical examination to determine the condition of the patient. The examination is by feeling a varicocele that is characterized by a hard mass above the testis and feels like a worm. The doctor can also ask the patient to exhale with the mouth and nose closed to clarify the enlargement of the vein.




To ascertain and look for the cause, the urologist can suggest a series of investigations, including:

  • Scrotal ultrasound. This examination aims to see the size of blood vessels and blood flow in detail.
  • Measurement of testicular volume. Tool for measuring testicular volume called an orchidometer.
  • Sperm examination. This check is done to see fertility.

Varicocele Treatment

Most varicocele cases do not cause symptoms and do not cause harm, so no treatment is needed. When varicocele causes pain, the doctor can treat it with pain medication, such as ibuprofen or paracetamol, to reduce pain. In addition, the doctor can ask the patient to wear testicular support pants to relieve pressure.

While varicoceles that cause severe pain or shrinking testicles, and infertility in men, action will be taken. Some ways you can do:

  • Embolization is done by inserting a tube to reach the venous location of the varicocele through the groin or neck. The doctor will enter substances to improve blood flow and varicocele. Embolization is carried out under general anesthesia and the procedure takes several hours.
  • The doctor will clamp or tie a blood vessel that becomes a varicocele to inhibit blood flow to these vessels and can flow to other normal blood vessels. Surgery can be performed with open surgery or a minimal incision technique with the help of a special instrument called a laparoscope. Surgery can be done with local or total anesthesia.

The healing process after treatment is 1-2 days, however, patients need to avoid strenuous activities for 10 to 14 days. In addition, a follow-up examination of a urology specialist also needs to be carried out for 3 to 4 months, especially those with varicocele accompanied by infertility.

Varicocele Complications

If not treated properly, the varicocele can cause the testicles to shrink and eventually not function at all. When it doesn't work, it's reproductive ability will be sacrificed. The testicles are no longer able to produce sperm and if possible, the quality is not as optimal as possible.



References

References

1. Macey, et al. (2018). Best Practice in the Diagnosis and Treatment of Varicocele in Children and adolescents. Therapeutic Advances in Urology

2. Urology Care Foundation. What are Varicoceles?


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