Varicocele: The ‘scrotal bag of worms’ you should know

Varicocele
A varicocele. Note the tortuous veins on the left scrotum.
Credit: Mens Health

A varicocele is an enlargement of the veins within the scrotum.

It makes the scrotum feel like a “bag of worms”.

They are described as the equivalent of varicose veins on the legs.

Varicoceles are similar to the varicose veins you see in peoples’ legs.

Exact cause is unknown, but it may be similar to that of varicose veins.

They affect around 15 percent of males, and tend to form between ages 15 and 25 years. It may occur in people higher than this age group.

It is not certain what causes varicoceles. But it is believed to be caused by failure of the valves of the veins draining blood from the testes back to the heart.

Varicocele is a cause of male infertility. It causes low sperm count (oligospermia) and decreased sperm quality.

Between 35 and 44 percent of men with primary infertility have varicoceles.

It may cause the testicles to shrink or become smaller.

Varicoceles are commoner in the left aspect of the scrotum compared to the right.

There are usually no symptoms associated with varicoceles but sometimes it might cause pain,swelling and discomfort.

Because varicoceles usually have no symptoms, it often requires no treatment.

Varicoceles are usually diagnosed during routine fertility examination or screening. In other cases, it is detected by accident.

Though clinical diagnosis is enough, scrotal ultrasound may be requested to confirm the diagnosis.

The treatment modality for complicated varicocele is surgery. This type of surgery is called varicocelectomy. It may be an open surgery or laparoscopic surgery. Percutaneous embolisation (non-surgical) is also a treatment modality.

In Nigeria, varicocelectomy costs about #100,000 Naira. It may be may or less depending on the centre and the surgeon(urologist).

Rarely, the complications are build up of fluid around the testes called hydrocele, recurrence, infection, abdominal pain, hematoma, and damage to the artery which can lead to loss of the testes.

The recurrence rate of varicocele is higher in embolisation than in open surgery.

Healing after surgery is fast and pain is often mild. Avoid exercise for 10 to 14 days. You can return to work 1 or 2 days after surgery.

For surgery done for fertility problems, semen analysis is done 3 to 4 months later, when new sperm develop.

Semen quality improves in 6 out of 10 infertile men after repair.

Update: Operative treatment (varicocelectomy) is required for
persistent pain or subfenility and involves venous ligation of the spermatic vein . Using an open surgical technique, the tributaries of the testicular vein may be ligated in the inguinal canal as they run in the spermatic cord. Alternatively, the testicular vein itself may be ligated in the retroperitoneum above the inguinal canal.
Minimally invasive methods may also be uscd to treat varicoceles. These inelude laparoscopic ligation and radiological embolization of the testicular vein

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Sources:

Mayoclinic

MedicalNewsToday

Urology Care Foundation

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