Veins are an important part of the cardiovascular system playing a key role in transporting blood from various regions of the body to the heart. Certain Venous malformations occur when veins tend to develop abnormally or get enlarged.
Varicocele also called Pampiniform Plexus is a term used to describe abnormally dilated, enlarged, and twisted veins in the scrotum. The scrotum is a slender bag of skin that holds testicles and several important parts of the male reproductive system. While veins have valves that ensure the blood moves in the proper direction, however, when valves in the testicular vein fail to work properly, gravitational force can make blood collect in the scrotum, causing a varicocele.
This ailment causes extreme scrotal discomfort, decreased testosterone levels and production by the testis, and fertility problems. A very common ailment, by and large, varicocele is not dangerous. One in seven men have a varicocele and for most of them, their varicocele does not possess a threat and it usually goes undetected throughout life. About twenty-five percent of adolescents form varicoceles during puberty and most likely, it tends to wither away spontaneously. For this reason, most people do not get them treated unless they cause pain, hormonal imbalances, or pain and discomfort. Related to the course of the testicular vein in the abdomen, this problem is not considered very dangerous, and it is like getting a varicose vein in your leg.
Problems Associated With Varicocele
Most of the time, varicoceles cause no problems and are harmless throughout life. However, in some cases, varicoceles begin to get discomforting and testicles start to shrink. This is also called Testicular Atrophy. A varicocele can result in decreased sperm production and quality leading to infertility besides decreased sperm count or an increased number of deformed and ineffective sperm. Varicocele can also cause a lack of sperm in ejaculation referred to as azoospermia. In some cases, there are problems with fathering a child as it poses long-term effects on fertility.
While the exact cause of this ailment is unknown, a possible reason is a problem with blood flow in the spermatic cord, which carries blood to and from your testicles. If valves inside the veins in the cord do not work as they should, the blood backs up and the veins get wider. Another cause of the ailment is when larger veins start to move from the testicles towards the heart and are connected differently on the left and right sides causing a sluggish blood flow. The blood begins to pool in the veins, and they cease to function efficiently. Therefore, more pressure is needed to keep blood flowing through the veins towards the heart. Moreover, when the blood flows backward or pools in the veins, it also causes them to swell. This can lead to sudden swelling of the scrotal veins causing complications.
The best way to diagnose varicocele is by self-examining the scrotum or a routine exam by the urologist who feels the scrotum above the testicle. The swollen protruding enlarged veins or varicocele is often described as a bag of worms, due to their worm-like appearance. The urologist may ask for a scrotal ultrasound in case the veins are not visible by the naked eye and to get the exact size of the testicles. Signs of varicoceles depicted in ultrasound are veins that are wider than 3 millimeters.
Often, varicoceles are not recommended to be treated. Only in the following cases, treatment is suggested:
- The patient has infertility issues and is unable to father a child
- There is extreme pain and discomfort
- During puberty left testicle is growing smaller than the right
- Semen analysis report shows abnormalities
- There is a fluid in the testicles
The two surgical approaches mostly used are:
Microscopic Varicocelectomy: A 2 to 3 hours process, during this surgical option, the surgeon makes a 1 cm incision above the scrotum. Using the microscope, the surgeon ligates all small veins and spares the vas deferens, testicular arteries, and lymphatic drainage.
Laparoscopic Varicocelectomy: With this technique, the surgeon inserts thin tubes in the abdomen and performs vein ligation. Because there are fewer veins to ligate in this process, the procedure is shorter, and it does not take beyond one hour to complete.
In both the above-mentioned surgeries, the patient is discharged and sent home the same day. Healing post-surgery is fast and patients can return to normal activities in six to seven days. Strenuous activities for a few days should be avoided. Problems after this surgery are rare but some possible complications can arise such as recurrence of varicocele or formation of fluid around the testicle. In extreme cases, the injury due to surgery can lead to loss of the testicle.