All About Varicocele Causes, Stages, Treatment Methods + FAQ
Varicocele is a varicose vein in the testicles. This is a disease that occurs most often in adolescents 14-16 years old. Often it leads to infertility. Currently, about 16% of men on the planet are diagnosed with varicocele. In 40-90% of patients with this disease, spermatogenesis disorders are detected.
Due to varicocele, spermatogenesis is impaired in most men
Causes of the occurrence and development of varicocele
Varicocele is more common in boys under 16
The disease occurs as a result of increased pressure in the veins located in the testicles. Most often the left side suffers, there are more veins. Among the main reasons for the appearance of varicocele, great physical exertion for a long time, the presence of diseases that cause an increase in intra-abdominal pressure, thrombosis, as well as malignant kidney tumors in the elderly are noted.
The development of the disease can be caused by not very good functioning of the vein valves in the spermatic cord. There is a reverse flow of blood from the renal vein to the testicular, and then into the bunch plexus of veins. The pressure in the vein cavity rises, significantly expands the walls of the veins, which contributes to the formation of nodes.
Stages of Varicocele
There are 4 stages of the development of the disease:
- Stage 1 At the initial stage, it is difficult to visually determine the presence of the disease. Even with palpation, this is impossible. In rare cases, mild pain in the testicle and spermatic cord may disturb, but more often the patient does not complain.
- 2 stage. The main sign of varicocele in the second stage is a significant increase in venous plexus. You can notice it during palpation. Rarely by visual signs can you diagnose an ailment at this stage.
- 3 stage. At this stage, the disease is determined without difficulty. The patient already feels discomfort associated with an increase in testicular veins. To diagnose the disease, a doctor’s examination is enough. During palpation, a thickening of the spermatic cord is often detected. The patient complains of pain in the groin, the scrotum is significantly enlarged, possibly reducing or changing the shape of the testicle.
- 4 stage. At the final stage, the disease is well defined by the naked eye and without additional diagnosis. The patient has asymmetry of the testicles and nodular veins in the area of the spermatic cord. The skin in the scrotum becomes rough and the muscles harden. When analyzing sperm, abnormalities in the reproductive system are noted. This is due to an increase in temperature in the scrotum, which negatively affects the vital activity of sperm. But even at this stage, the patient does not always feel pain. It occurs only with intense physical exercise and having sex. At this stage, the risk of infertility in men is high.
If at stage 1 there are practically no symptoms, then at stage 4 – varicocele can be seen with the naked eye
At the 1st stage of the disease, the only clinical manifestation may be changes in the spermogram, and a violation of the functioning of the veins is detected only with an in-depth study on infertility.
It is possible to detect the presence of a disease in a person at the 2nd stage when examined in a urologist’s office. To clarify the diagnosis, additional studies are prescribed – spermogram, ultrasound and doplepleography.
Ultrasound and doppleography when diagnosing varicocele must be performed in two positions of the patient: standing and lying. When performing an ultrasound, the condition of the appendages and testicles is assessed, possible pathologies are identified. More accurately determine the presence of varicocele will allow doppleography. It allows you to determine the presence and amount of reverse blood flow.
MRI and ultrasound are also performed to exclude other diseases that lead to the occurrence of varicocele. The focus is on the kidneys and retroperitoneal space. Thus, vascular thrombosis and the presence of tumors are detected.
Patients who have already reached 15 years of age pass a semen analysis – a spermogram. The laboratory determines the number of sperm, their activity. Changes in the spermogram are a direct indication for the treatment of varicocele, even if there are no more complaints, and the aesthetic aspects of the patient are not important.
Patients older than 15 years are given a spermogram
Indications for therapy
Since children and adolescents are more likely to suffer from varicocele, there are strict indications for prescribing medications and, especially, surgeries:
- signs of impaired testicular function (a decrease of more than 20% in comparison with a healthy one);
- pain or psychological discomfort;
- spermatogenesis disorders in patients older than 15 years.
Non-surgical treatment of varicocele
At the initial stage of the disease, you can not rush into the operation, especially if the disease is asymptomatic. At this stage, phlebotonics and venoprotectors, antioxidants will help support the work of veins. Discomfort can reduce the wearing of a special suspension.
In general, urologists do not recommend surgery to patients under 18 years of age, since in this case relapses are frequent. Conservative treatment should be accompanied by regular monitoring of the patient’s condition using dopplerography. But we must remember that the changed walls of the veins cannot be returned “to normal” with any ointments and tablets, they can only slow down the process in the initial stages.
With the progression of varicocele, conservative treatment will not help, surgery is indicated
In the 2016 clinical guidelines for the treatment of varicocele in children and adolescents, operations with ligation of veins above pathologically altered areas are recommended as the main treatment method (details of how the operations are performed will be described below). But it is also possible to carry out endovascular sclerotherapy .
In this case, special preparations are introduced into the lumen of the altered vein, which “stick together” the venous walls. Thus, the affected area is “turned off” from the bloodstream, and other veins take over its functions.
Sometimes patients with varicocele are prescribed embolization. The essence of this method is that a spiral is inserted into the testicular vein, which blocks the flow of blood through the vein.
Indications and preparation for surgery
Main article: Varicocele surgery: types, preparation and rehabilitation
Surgical intervention is prescribed for the ineffectiveness of conservative therapy and the appearance of signs of impaired testicular function. But if there are signs of significant testicular atrophy, then in such cases, the operation will not help restore the normal functioning of the sperm. That is why conservative treatment of varicocele should take place under the constant supervision of a specialist.
The choice of a specific method of surgical intervention depends on several factors:
- general physical condition of the patient;
- the state of the venous system of the testis and scrotum;
- violations of the venous blood flow of internal organs;
- clinic features.
Indication for surgery – testicular atrophy with varicocele
You can not do surgery for such concomitant pathologies as:
- bleeding disorders;
- decompensated diabetes mellitus;
- inflammatory processes of the genitals and urinary system;
- acute cardiovascular pathology (heart attack, stroke) and chronic decompensation.
Before the operation, the following examinations are performed:
- clinical blood test;
- blood biochemistry;
- Ultrasound and doppleography of the veins in the scrotum;
- analysis for HIV and syphilis.
Surgery for varicocele
This is one of the least traumatic methods. Several punctures are made in the peritoneum through which the instruments are inserted. Unfortunately, such an operation cannot be performed if there are adhesions in the abdominal cavity.
Under the control of the endoscope, the changed veins of the vascular bundle of the testicle are bandaged. Thus, the blood flow through them stops and eventually the veins fall.
Laparoscopic surgery for varicocele – low-traumatic intervention
The most effective surgical treatment for varicocele is Marmara surgery. Its meaning lies in the ligation of the testicular veins in the groin. This operation can be performed under local anesthesia.
The incision is made in the area of the external inguinal ring. Further, separating the tissues layer by layer, they reach the venous plexus, the changed veins are separated from the lymphatic collectors and bandaged. After that, the normal anatomical arrangement of all structures is restored and postoperative wounds are sutured.
This operation is considered gentle and is often recommended for children and adolescents: the length of the incision is only 2 cm.
After surgery, there is a layered suturing of the incision
Another common surgical method for treating the disease is Ivanissevich’s operation. This technique is outdated, and the likelihood of relapse and complications when using it is quite high.
Ivanissevich’s operation is performed under local anesthesia. The surgeon makes an incision in the iliac region. After this, the testicular veins are separated and ligated. The spermatic cord with the veins of the plexus plexus is excised and ligated. After all necessary manipulations, the wound is sutured in layers.
This operation requires a long rehabilitation: for example, physical activity is contraindicated for up to six months. At the first stage, patients need a hospital, during which they take painkillers to neutralize pain. To prevent the occurrence of infection, the attending physician prescribes antibiotics. A postoperative wound heals on average 10-12 days. The number of relapses after this treatment method reaches 30%.
The purpose of this operation is to restore testicular function. Microsurgical operations will eliminate the disease and normalize blood flow from the testicle.
At the first stage of the operation, the surgeon makes an incision parallel to the inguinal canal. Next, the testicular vein is removed through the wound with the release of the epigastric vein. After that, the doctor removes the entire testicular vein, and instead, the epigastrium is hemmed. Then the wound is sutured in layers.
After a less traumatic surgical intervention, there are practically no complications
After a microsurgical operation, patients have a marked improvement in blood circulation from the scrotum. For this reason, the risks of complications are minimal.
As a result of the operation, good conditions are created for the restoration of the main functions of the testicle.
Recently, doctors are increasingly resorting to laser surgery in the treatment of varicocele. It allows you to eliminate a double-sided varicocele at a time, which is impossible to do with other methods of surgical treatment. Laser surgery does not require anesthesia, and the rehabilitation period lasts several days.
Manipulations are carried out using an endoscope that passes through the vessel. Under the influence of the laser, the affected areas “stick together” and are excluded from the bloodstream.
After the operation, patients in the first weeks to months must adhere to all the doctor’s prescriptions. Especially we are talking about those patients who underwent surgery Ivanissevich.
In the first two days after surgery, it is better to lie. Walking can be done, but very short to get a portion of fresh air. No weights can be lifted. Remove dressings and wet them in the early days is prohibited.
Ointments and other medicines should not be used to quickly heal a wound. After 5-7 days, the stitches themselves will resolve.
Weights must not be lifted weighing more than 4 kg within 7 days after surgery. It is forbidden to take a bath and shower for 5 days after the operation. You can eat all the products from the usual diet. An exception for overweight people with stomach problems. For them, the doctor makes a diet.
Doctor’s recommendations for taking antibiotics are strictly implemented
It is possible to add physical activity (with the exception of weight lifting) after 8-10 days, and only after the consent of the doctor (except for the operation of Ivanisevich: with it, sport is contraindicated for up to six months). You can run, ride a bicycle in 3 weeks and only with the approval of a doctor. You can have sex and masturbation 10-12 days after minimally invasive operations and 3-4 weeks after open access surgery (Marmara, Ivanissevich).
If the doctor has prescribed antibiotics, then all prescriptions for taking them should be strictly observed even with a noticeable improvement in well-being.
Possible complications and relapses after varicocele surgery
The operation may be complicated by bleeding and infection. Urgently need to see a doctor if:
- temperature rises above 38 ° C;
- the scrotum increases sharply in size, acquires a blue color, painful;
- purulent discharge with an unpleasant odor appears from the wound;
- divergence of the edges of the scar.
Such unpleasant consequences as uneven scrotal edema, pain in the wound area disappear on their own as they recover.
Is it possible to get rid of varicocele at home?
With varicocele, as with any varicose veins, the structure of the venous wall changes. It is impossible to restore it to its previous state with either home remedies or medicines: venotonics and venoprotectors are only able to slow down the process of degradation for some time.
Can varicocele cause infertility?
Yes. Infertility is the main complication of varicocele. Stagnation of blood in the scrotum area causes overheating of the testicle, which disrupts the functioning of spermatogenic epithelium.
Is the ability to conceive after surgery restored?
Yes, in most cases after a successful operation. But we must remember that the process of spermatogenesis lasts about 72 days. After 3-6 months, you can count on a full sex life with the possibility of conceiving a child.
Does varicocele affect an erection?
Potency disorders are rarely mentioned when listing symptoms of varicocele, possibly due to the fact that most patients are children and adolescents. But there are studies showing that with this disease, testosterone synthesis is reduced, which can indirectly affect an erection.
Does the operation affect the erection?
If the operation is done correctly, it does not affect.
Can a varicocele be cured without surgery?
No, for the reasons stated above.
Does the testicle function after surgery?
If the operation was done in a timely manner, before irreversible changes in its function occurred.
If there is no discomfort and pain, but only external changes, can you not rush into the operation?
The decision on the timing of the operation is made by the doctor on the basis of diagnosis and analysis. Not always the absence of pain allows you to postpone the operation: a violation of spermatogenesis requires immediate intervention.
How much time does the dilated vein fall after surgery?
From a month to six months, depending on the type of operation. When using laser surgery and the Marmara method, veins fall much faster than with the Ivanissevich technique.