Diseases of the male reproductive system: varicocele

Varicocele is one of the most frequent diseases of the male reproductive system. It is an abnormal swelling of the veins of the testicle and affects about 15% of the adult male population

What is varicocele?

Varicocele is caused by a pathological reflux of blood from the left renal vein to the testicle.

The result is blood stagnation, increased temperature and poor tissue oxygenation.

The reflux leads to increased pressure in the veins of the spermatic cord and raises the temperature in the scrotal bursa.

A temperature slightly below the internal temperature is essential for the proper functioning of the testicles, which is why they are located in a sac outside the abdomen (scrotum).

Large varicose veins in the scrotum act like a ‘radiator’ and can cause a decrease in the production and quality of seminal fluid, leading to infertility.

It mainly arises during puberty, between the ages of 11 and 16, and affects the left testicle in 95% of cases.

What are the causes of varicocele?

The underlying causes of varicocele are not yet fully known.

It is believed that a major role behind this disorder is played by a congenital weakness of the vein walls associated with incontinence of the valves, which with time – and especially during puberty, when the testicles grow faster – can cause the veins to dilate.

What are the symptoms of varicocele?

Most of the time, varicocele is asymptomatic and a medical examination is therefore necessary to diagnose it.

In other cases, various symptoms may be experienced:

  • Dull pain in the affected testicle.
  • Sense of heaviness or discomfort in the scrotum (especially after physical exertion, after a day spent standing or sitting for too long).
  • When the varicocele is high, the dilated veins at the level of the testicle may be palpable and visible.
  • The affected testicle may be smaller and in a lower position than the other.

Diagnosis of varicocele

For diagnosis, it is necessary to undergo a medical examination.

The specialist may request a testicular ultrasound with doppler of the sperm vessels, to define the extent of the venous reflux, and/or a spermiogram, to estimate a possible deterioration of fertility.

It is very important to diagnose varicocele early in order to avoid compromising fertility and the health of the affected testicle.

There are numerous surgical and radiological techniques to correct varicocele

Generally, there is a tendency to prefer minimally invasive techniques that make the operation very safe.

The one adopted in many hospitals consists of a small sub-inguinal incision through which the varicose veins are exteriorized and sclerosed anterograde (from the bottom to the top).

This procedure reduces the risk of recurrence compared to classical techniques, and considerably shortens operating, hospitalisation and physical recovery times.

The procedure is not painful and anaesthesia can be local or with deep sedation.

How can varicocele be prevented?

Unfortunately, there are no known strategies to prevent its development.

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