What is Varicosele?
Testes have been placed inside the testis sac called scrotum, which is loose and elastic. The testes began to form at the waist region in mother womb and beginning from the 7th month of pregnancy, they descend towards the groin and settle in the scrotum. Owing to this process, the blood vessels of the testes come from the waist region. Inside the testis sac (scrotum), the testes are suspended on the blood vessel stem that comes from the waist region. Varicosele occurs when the venous veins in this stem expand more than normal. It can be seen by naked eye on the surface of the scrotum in form of many worm-like loops.
What is the Cause of Varicosele?
The exact cause of varicosele is unknown. It is more common in the left. It is thought that as the venous vein (carrying dark blood) on the left opens more vertically upwards, varicosele is more frequent therein. Meaning that blood flow to the main vessel is difficult, which causes vessel expansion (Varicosele). Another cause is defective or missing valves inside venous vessels. But the ultimate cause isn’t known.
Does varicosele lead to infertility?
Infertility is explained by the toxic effect of this dark blood that accumulates inside the expanded vessel and its increasing of temperature within the testis. It is rare in the right testis as the flow therein is easier.
Varicosele may therefore cause sperm disorders. It may also disrupt the normal development of testis. The testes may shrink.
Symptoms of Varicosele
It is present in 20/100 of men. Only 20 percent of this leads to infertility. Meaning that only 4 percent of total varicosele leads to infertility. Varicosele generally has no symptoms. But there may be pain in both testes. Varicosele is coincidentally identified during examination performed for this pain. But the main cause for this pain is the stretching of testes due to excessive sexual desire during puberty. It disappears with masturbation. One should avoid immediate varicosele surgery.
Advanced varicosele may lead to pain mainly on the left side. Pain is stopped by drugs. Surgery is never performed without a sperm test.
Diagnosis of Varicosele
It is very easy to diagnose varicosele. Varicosele can be seen and diagnosed by a simple physical examination. Varicosele can be felt by hand. Majority of varicosele cases don’t cause any complaints. Pain may occur in rare cases. Only 5-6 percent of varicosele cases require surgery. One should avoid unnecessary surgery.
When should Varicosele be Operated?
As many Varicosele cases don’t cause any symptoms, the physician coincidentally diagnoses varicosele while he physically examines the male in infertile couples. In addition, adolescent males apply to physician due to pain and swelling in the scrotum (testis bag). Testis cancer can also be seen during puberty. Testis cancer has similar symptoms with varicosele. For this reason, one should always perform ultrasonography after a good physical examination. Only this can conclusively diagnose the presence of testis cancer or varicosele.
There is no need to operate varicosele that don’t cause serious pain and shrinkage in adolescents. These patients should be monitored periodically and evaluated with sperm analysis around 17-18 years of age.
Advanced varicosele that causes shrinkage in the penis should be operated. Pain alone isn’t sufficient cause for surgery. Sometimes, intense pain in testes may be confused with testis torsion in adolescents. Therefore, an urologist should always see it. Testis torsion, which means the turning of testis around its stem, requires immediate surgery.
Surgery is required if it is understood that the cause of infertility is varicosele and the testis has begun shrinking. By a 2 cm small incision on the groin region, the expanded blood vessels in the inguinal channel are found by microscope or loupe (magnifier). They are tied and terminated. This allows normal blood drainage. Other blood vessels in the testis are sufficient for draining blood. Therefore, termination of the expanded vessel doesn’t affect the testis. The patient can be discharged within the same day. He returns to normal activity within 1-2 day. Amelioration in sperm quality begins at the 4th-6th months at the earliest. Amelioration in sperm quality continues for 2 years while increasing. This open varicosele surgery is called Micro Surgical Loupe Inguinal approach.
Other methods perform a similar procedure by entering the abdomen from above with a laparoscope (closed method). It is not preferred. It has not been popular. It inflicts more trauma on the patient.
Another method is Percutaneous Embolization performed by radiologists. A solution that clogs the expanded blood vessel is administered inside vein. Or a stent is applied. It is a more exhaustive method for the patient.
Open surgery that uses microscope and loupe is the most appropriate treatment method.