Varicocele

Testicles are a pair of reproductive organs located in a pouch of skin called the scrotum. And, varicocele is the name given to the enlargement of the veins of the testicles. Varicocele is similar to the varicose veins seen in legs.

It is one of the common reasons for low sperm production, poor sperm quality, and male infertility. Varicocele may also disrupt the development of the testicle and lead to testicular shrinkage. However, there is no rule that every varicocele will affect sperm production.

The incidences of varicocele increase with age: Fortunately, varicocele is an easily diagnosed disease and not all varicoceles require treatment. If required, the most common treatment method for varicocele is a surgical operation.

Varicocele generally does not show any symptoms. But, it may sometimes cause pain in the testicle.

The intensity of the varicocele pain increases with physical exercises and standing for long times. It tends to increase later in the day and decreases when you lie down and rest. Varicocele progresses and becomes evident in the scrotum over time.

As the varicocele may adversely affect the sperm quality and the count, especially in young men, it is treated with surgery.

Although there is no clearly defined reason for varicocele, it is thought to be caused by the malfunction of the valves in the veins of the testicle. As a result of the malfunction of these valves, the veins enlarge, and the venous blood accumulates in and around the testicle, which may lead to poor sperm quality or count.

Due to the position of the left testicle vein, varicocele is generally seen on the left side. However, it is known that unilateral varicocele may disrupt sperm production in both testicles.

For now, there is no clearly defined factor that increases the development of varicocele. However, in some studies, it has been revealed that varicocele is seen less in overweight and more in taller people.

The most important method for diagnosing varicocele is physical examination. Your doctor examines your testicles while you are standing and try to feel the enlarged veins. Your doctor may ask you to strain while holding your breath or to cough. Therefore, the enlarged veins that cannot be felt otherwise can be felt.

Color Doppler ultrasonography is the most significant imaging method to diagnose varicocele. In this method, both vessel diameters and the direction of blood flow in the veins can be determined. In this way, it is determined whether there is a backward flow of venous blood.

Varicocele is not a condition that always needs to be treated.

In couples who are married and have difficulties in having children; varicocele should be treated if there is a clinically detectable varicocele, and the female factor has been investigated and no problem found, or if there is deterioration in any of the parameters in the spermiogram test.

Unmarried adult men with deterioration in the sperm parameters should get treatment.

For young adults, if the sperm parameters are normal, the situation may be followed up with yearly spermiogram tests, and no treatment may be required.

In adolescence, if the size of the affected testicle is smaller than the other testicle and if there is growth retardation in it, treatment is required. Otherwise, close follow-up is sufficient.

Varicocele cannot be treated with medication. So, the treatment options consists of invasive methods. These methods are open surgery, laparoscopic surgery, and angioembolization.

Open surgery has changed with advanced technology today. With the start of using microscopes during operations, the surgeons’ visual ability and thus the success of the operations have significantly increased. Varicocele surgeries performed under microscopes are called microscopic varicocelectomy.

Laparoscopic varicocele surgery is performed with the help of cameras through the three holes opened in the abdomen. It is not frequently preferred for the treatment of varicocele due to reasons like it certainly requires general anesthesia, bears the risk of injury to the abdominal organs, and the size of the skin incision is larger than that of open surgeries.

Angioembolization is a procedure in which a radiologist reaches the enlarged testicular veins through the veins of the groin or neck, and occludes the testicular veins from inside. It is rarely used today.

There is no herbal treatment with scientifically proven efficacy today for the treatment of varicocele. Varicocele is the enlargement of the veins, causing the venous blood flow back. And for now, there is no medicational treatment with proven efficacy that could turn this enlargement back. Microsurgery has proved its efficacy and reliability in the treatment of varicocele.

Varicocele surgeries performed under microscopes are called microscopic varicocelectomy.

Today, varicocele surgeries performed using the microsurgical method are accepted as the gold standard method for treating varicocele. The surgery is carried out through a two-centimeter incision in the inguinal region. All enlarged veins of the testicle are ligated under the microscope. The advantage of using a microscope is that it allows seeing all veins and protecting the arteries thanks to the increased visibility. With the microsurgical varicocelectomy operation performed with experienced hands, the possibility of varicocele recurrence is reduced, and the risks associated with the operation are minimized.

Although varicocele operations are very rare, there are risks such as the formation of fluid around the testicle (hydrocele), recurrence of varicocele, injury to the arteries, or testicular atrophy.

Although these risks are observed at different rates according to the surgical method used, they are seen less in microsurgical varicocelectomy.