Varicocele
Overview
A varicocele is an abnormal enlargement of the scrotal veins which drain blood from each testicle. Varicoceles are the most common cause of abnormal semen analysis, low sperm count, decreased sperm motility, and abnormal sperm morphology. Varicoceles are usually painless and are classified as small, medium, or large based on their clinical appearance and size.
Varicoceles occur in around 15% to 20% of all men and are found in about 40% of infertile men. Exactly why a varicocele impacts the production, structure, and function of sperm is unknown, but researchers are working to confirm several theories. The exact cause of varicoceles is unknown, but one contributing factor may be that blood gets backed up in the network of veins, which then dilate to accommodate the swelling, causing the varicocele. Varicoceles are far more common in the left testicle, accounting for 80% to 90% of the cases. If a left varicocele is detected, there is a 30% to 40% chance that this condition occurs in both testicles, known as a bilateral condition.
Diagnosis
Varicoceles are usually asymptomatic. If the varicocele is large enough, you may see a mass like a “bag of worms” above the testicle. Varicoceles present as soft lumps above the testicle, usually on the left side of the scrotum. Right sided and bilateral varicoceles may also occur. You may also feel a dull, aching pain or heaviness in the scrotum.
Varicoceles are often found during an infertility workup. Large varicoceles are easily identified during a visual inspection, during a physical examination, due to their appearance. Medium varicoceles are identifiable by palpation during a physical examination without you having to bear down. Small varicoceles are identified only during a strong Valsalva maneuver, also known as bearing down. This is when you take a deep breath, hold it and bear down in a similar way to the pressure you create during a bowel movement.
After the physical exam, the varicocele can be confirmed with high-resolution color-flow Doppler ultrasound, which will show a dilation of the veins. A venography is unnecessary in most cases.
Treatment
There are no effective medical treatments. If a varicocele is causing pain or discomfort, analgesics and scrotal support may be used short term. Microsurgical techniques, like laparoscopic surgery, help to identify small anastomosing vessels that might otherwise be missed. Percutaneous embolization can also be performed, usually with interventional radiology.
Why GMI
At the GMI, Department of Urology, a dedicated team of internationally acclaimed physicians guides each patient through their entire journey, from their diagnostic work-up to their treatment and post-treatment care.
The GMI team will never offer a simple “one size fits all” approach to any patient. We believe each patient’s case is as individual as they are, and strive to find the best solution for each of our patients, taking their specific case and diagnosis, their lifestyle, and choices into account.
We believe each of our patients is more than their diagnosis. That’s why our dedicated paramedics team supports patients on their journey by offering more than just expert medical care. We offer psychological help, integrative services (including yoga classes, and acupuncture) and have a GMI Patient Advocacy Program.
Adhering to our passion for innovation, and desire to progress the medical field, the GMI Department or Urology both initiates and participates in several clinical trials in which the most modern and advanced treatment concepts are tested.
