A varicocele, or varicose vein hernia, is a varicose vein-like enlargement of the testicular vein and venous network in the scrotum (testicles), which is the most common cause of male infertility. Varicoceles are treated surgically or with sclerotherapy (sclerotherapy), which in many cases can reverse existing infertility.
What is a varicocele?
A varicocele (ruptured varicose vein) is a varicose vein-like widening, lengthening and meandering of the testicular vein (vena testicularis) and the venous network in the testicles and epididymis (so-called plexus pampiniformis). For childish fat foot meaning, please visit phonejust.com.
About 10 to 20 percent of men, especially between the ages of 15 and 25, can be affected by a varicocele, which usually causes no symptoms. Only in some cases does a varicocele manifest itself as a pulling pain in the testicles and groin area, which occurs in particular during physical exertion.
Depending on the extent of its development, a varicocele impairs fertility (fertility) via various mechanisms (including an increase in body temperature in the area of the testicles) and is the most common cause of sterility (infertility) in men, with surgical removal or sclerotherapy of the varicocele reducing fertility in can be restored in many cases.
Causes
In most cases, a varicocele is due to a hereditary disturbance in the flow of blood from the testicular vein into the left renal vein (primary varicocele). This impairs the functionality of the venous valve in the testicular vein, which in turn leads to an increase in pressure in this blood vessel.
The increase in pressure causes the varicose vein-like expansion of the testicular vein or the entire venous network in the testicle, which is characteristic of varicocele. The disturbance of the blood flow can be caused by a narrowing of the renal vein through the aorta (main artery) or the aortic branches or by an anatomically unfavorable transition of the testicular vein into the renal vein.
In addition, tumors can increase pressure as they expand, and ruptured vessels or blood clots can disrupt blood flow. In the latter two cases, we speak of symptomatic varicoceles.
Symptoms, Ailments & Signs
A varicocele (rupture of a varicose vein) usually causes no symptoms. It is often only discovered by accident during investigations. However, sometimes there are complaints. In individual cases, the rupture of varicose veins can even lead to infertility in the affected men. However, testicular varicose veins are relatively common.
Up to 20 percent of all young men are affected by a varicose vein hernia. Varicose veins usually develop in the left testicle. They can also be felt manually there. In rare cases, varicoceles show symptoms, which are then very characteristic. A heavy scrotum with a sore feeling is typical. Intense pain in the testicles can occur, especially when standing. Worm-like swellings on the scrotum are often observed, which are often noticeable when there is increased abdominal pressure during pressing.
But even without abdominal pressure, this swelling can occur. Sometimes the affected testicle is smaller because its growth is disturbed by the network of varicose veins. The varicose veins create a backlog of blood near the testicles, causing a higher temperature there.
Since testicular development and sperm production are very temperature-dependent, the varicocele can lead to reduced sperm production. In extreme cases, sperm production stops altogether, leaving the patient infertile. However, since only one testicle is usually affected, fertility is usually preserved with a varicocele.
Diagnosis & History
Varicoceles are usually diagnosed during a physical exam in which the testicles are palpated in different positions (standing, lying, squatting). Statements about the stage are already possible here. First-degree varicoceles can be felt as worm-shaped balls while standing and doing the Valsalva maneuver (abdominal crunch).
Second-degree varicoceles, on the other hand, can be palpated without a Valsalva maneuver while standing, while third-degree dilatations of the venous network can be seen through the skin through the varices (varicose veins). Subclinical varicoceles (initial stage), on the other hand, can only be detected in the context of a Doppler sonography (ultrasound of vessels) using the Valsalva maneuver.
With the help of sonography, a kidney tumor can also be ruled out and the structure and size of the testicles can be determined. A phlebography (X-ray image with contrast medium) provides information about the functionality of the venous network. If left untreated, a varicocele leads to infertility.
Complications
A varicose vein can cause various complications. First of all, there is a risk that the rupture of the varicose vein will lead to impaired sperm formation. This can result in infertility and infertility. Serious testicular dysfunction can also occur if the varicose vein is left untreated.
This is usually accompanied by severe pain, which can be a great burden for those affected. If the varicose cell is based on a kidney tumor, this can cause further complications. If there is no treatment, kidney failure, metastases form and, in the further course, the patient dies.
During an operation, organs and structures in the area of the operation can be injured, for example the vas deferens or the urethra. Bleeding, hematoma and nerve damage can occur. Injury to a testicle cannot be ruled out either. In some cases, a so-called hydrocele occurs, an accumulation of water in the scrotum, which can be associated with pain and dysfunction.
If the patient is allergic, there is a risk of an allergic reaction to the agents and materials used. Interactions with the prescribed medication can also occur and sometimes result in serious health complications.
When should you go to the doctor?
Due to its characteristics, varicose veins can only occur in sexually mature boys and men. The affected person often remains symptom-free for a long time, which is why a diagnosis is made during a routine examination. It is generally advisable to carry out regular health check-ups. This enables early detection of existing diseases and can contribute to the timely application of appropriate treatment methods. Abnormalities and peculiarities of the scrotum should be discussed with a doctor.
If there are complaints during the sexual act or ejaculation, the cause needs to be clarified. In the case of an unfulfilled desire to have children, medical tests can be used to find out which disorder is causing this circumstance. Therefore, a doctor should be consulted if, despite all efforts, pregnancy still does not occur after a few months. If an uncomfortable body sensation occurs when pressure is exerted on the scrotum, the observation should be discussed with a doctor.
If the size of the testicles differs greatly, this can be interpreted as a warning signal. Consultation with a doctor is recommended so that it can be clarified whether there is a need for treatment. Pain in the genitals, irregular locomotion, or impaired range of motion should also be evaluated. They lead to disturbances in everyday life and, in severe cases, can trigger complications that should be avoided.
Treatment & Therapy
The therapeutic measures for a varicocele depend on the extent and stage of the disease. With increasing symptoms and a pathological spermiogram (analysis of the ejaculate), what is known as transcatheter sclerotherapy to obliterate the varicocele is now preferred.
With this treatment method, a distinction is made between retrograde and antegrade varicocele sclerotherapy. As part of a retrograde sclerotherapy, the groin vein is punctured, from where a catheter is pushed through the renal vein to the expanded area of the venous network and the sclerosing agent is then injected through the catheter. In an antegrade sclerotherapy, a catheter is placed directly into the dilated vein, through which the sclerosing agent is injected.
Antegrade sclerotherapy is usually performed under local anesthesia, since the patient should bear down if possible during the procedure. In addition to these non-surgical procedures, surgical methods are used to treat a varicocele. Here, either the entire vascular bundle (operation according to Palomo) or only the Vena testicularis (testicular vein) is blocked (operation according to Bernardi). In both cases, this is done either via an incision in the lower abdomen area or laparoscopically (buttonhole surgery) with the help of several small incisions.
With the inguinal surgical method, the incision is made directly at groin level and all veins of the spermatic cord are tied off. All of the treatment methods mentioned for a varicocele are rated as equally good in terms of therapeutic success.
Prevention
Since varicoceles are due to a disturbed blood flow in the testicular vein (testicular vein), which is usually genetic or anatomical, it cannot be prevented directly.
Aftercare
If the varicocele is treated surgically and the procedure is performed on an outpatient basis, the patient cannot drive a car or any other means of transport for 24 hours afterwards. Machines are also not allowed to be operated and important decisions are better made on another day.
Following the surgical procedure, it is advisable for the patient to rest in bed for at least one day. Even after that, physical rest for about 14 days is recommended. Sporting activities must be avoided during this period.
For postoperative treatment, the scrotum should be regularly cooled with ice for the first 24 hours. This procedure can prevent possible bleeding. The staples or threads that are applied during the surgical procedure usually resolve on their own. Threads where this is not possible are removed by the doctor after about eight days. Obtaining the check-ups is very important.
After the treatment of the varicose vein hernia, it is recommended to put on elastic underpants, which serve as a support for the scrotum. Alternatively, wearing a scrotum holder is also possible. The patient can shower again two days after the operation. After removing the sutures or staples, he can also take a bath again.
You can do that yourself
The varicocele must be treated by a doctor. Weakly pronounced varicose veins usually do not require treatment, but diagnosis and observation are necessary. Patients should pay close attention to any unusual symptoms and consult the urologist if necessary.
A larger varicocele must be surgically removed. Rest and bed rest apply after such an operation. Pain can occur in the first few days after the procedure, which can be alleviated by gentle cooling. In consultation with the doctor, the use of natural remedies is also permitted. Cooling agents have also proven their worth, for example marigold ointment or a cool pad with green or black tea. At the same time, it is important to keep an eye out for unusual symptoms. Bleeding or pain reactions can occur, which must be clarified by a doctor.
If infertility occurs as a result of the varicocele, therapeutic advice is required. Above all, men with a strong desire to have children or who are actively planning a family need the support of a specialist to process the incision. It may also be useful to talk to other people affected. In addition to self-help groups, there are forums on the Internet. Specialist reading and the search for alternative options are also important self-help measures after a difficult varicocele.
