WHAT IS A VARICOCELE?
Varicocele is a term used to describe abnormally dilated veins (called the “pampiniform plexus” of veins) in the scrotum.
HOW DOES A VARICOCELE FORM?
Veins throughout the body carry blood from various organs back to the heart. Normally, they have valves that ensure the blood moves in the proper direction. However, when valves in the testicular vein don’t work properly, gravity can make blood collect in the scrotum, causing a varicocele. They usually occur on the left side, likely related to the course of the testicular vein in the abdomen.
WHAT PROBLEMS ARE ASSOCIATED WITH VARICOCELES?
Varicoceles can cause three main problems: Impaired fertility, decreased testosterone production by the testis, or scrotal discomfort. For this reason, they are not usually treated unless there is reason for concern about one of these problems. In some cases, varicocele can cause azoospermia, or the complete lack of sperm in the ejaculate.
HOW DOES A VARICOCELE AFFECT THE TESTIS?
One way is by carrying warm blood from the abdomen down towards the testis in the scrotum. The testis functions optimally at around 3 degrees below body temperature, thus this warmer blood can affect its ability to make sperm and testosterone. Other theories include mass effect on the testis as well as exposing the testis to various chemicals from the adrenal gland, which sits near the top of the testicular vein.
ARE VARICOCELES DANGEROUS?
Varicoceles are not life threatening, but rarely they can be associated with dangerous conditions. For example, if a varicocele forms on the right side and not the left, it is important to make sure there is no mass or other abnormality in the abdomen that might be causing it.
Also, varicoceles should “reduce” or decrease in fullness when a patient is lying down since the gravity no longer fills the pampiniform plexus of veins. When a varicocele doesn’t reduce, it also raises concern that there is an abdominal blockage such as a mass or tumor that could be causing the mass.
WHAT IS THE “GRADING” SYSTEM FOR VARICOCELE SIZE?
Varicocele grading systems help characterize the size of varicocele, which then helps to guide treatment. Various systems have been created, but below is the most commonly used scale today:
below is the most commonly used scale today:
|Seen on ultrasound, but not physically detectable (also called “subclinical varicocele”)
|Palpable (felt on exam) when the patient is performing the valsalva maneuver (“bearing down”)
|Palpable even without valsalva
|Varicocele causing visible deformity of the scrotum.
WHEN ARE VARICOCELES USUALLY FOUND?
Varicoceles are usually found due to one of the following scenarios:
- Most commonly, it’s found in a completely asymptomatic man being evaluated for infertility.
- A mass in the scrotum may be detected by the patient or by a physician during routine exam.
- A man may present to a physician with pain in the scrotum.
What kind of pain does a varicocele can a varicocele cause?
However, mild or severe scrotal pain can result from varicocele. Patients typically report an “aching” sensation in the scrotum, usually associated with prolonged standing or activity. The discomfort is commonly relieved by lying supine (on one’s back) and raising one’s feet.
Varicoceles may cause more severe pain if the veins develop thrombophlebitis (blood clotting and inflammation). The evaluation of patients with scrotal pain should include scrotal ultrasonography to rule out other pathology and urine tests to rule out infection.
VARICOCELE AND FERTILITY
Varicoceles are found on physical examination of roughly one-third of men being evaluated for failure to conceive. They are categorized by size (see the grading system, above) and by their presence on one or both sides of the scrotum. It is important to know that varicoceles of all sizes may affect fertility. In addition, new evidence shows that sperm function may be affected by varicoceles in ways that are not detected by semen analysis.
A varicocele on one side of the scrotum has an effect on both testes in regards to function and temperature.
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