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Varicocoele - varicocele

 
A varicocoele is an abnormal enlargement of veins leading away from the testicles caused by the backflow of blood. This is essentially the same process that leads to varicose veins in the legs.

A varicocoele (pronounced var-uh-ko-seel and sometimes spelled varicocele) are usually harmless, sometimes with few or no symptoms, but they have been associated with male infertility. It is estimated that up to 20% of men will have a varicocoele but in men with fertility problems, this increases to 40%. 

Signs and symptoms

Each testicle is supplied by a spermatic cord. As well as containing veins, each spermatic cord contains arteries, lymphatic vessels, nerves and one of the vas deferens (the tubes that carry sperm). 

The veins carry blood away from the testicles towards the heart - small valves within the veins prevent blood flowing in the other direction.  However, if these valves do not work properly, blood can backflow increasing the pressure within the veins and causing them to become enlarged, creating a varicocoele.

Varicocoeles almost always affect the left side of the scrotum and most commonly occur in men between the ages of 15 and 25 years.  The reason varicocoeles develop is not fully understood. They usually develop slowly and may produce no symptoms. If symptoms do occur they may include: 

  • A dull ache in one or both testicles
  • A dragging or heavy feeling in the scrotum
  • Swelling in the scrotum (this is often described as feeling like "a bag of worms")
  • The testicle on the side of the swelling is often smaller, due to alterations in blood flow
Symptoms may be more noticeable after exercise, standing for long periods, or during hot weather. Symptoms may reduce, or disappear altogether, when lying down.

Diagnosis

In order to make an accurate diagnosis the doctor will take a medical history and will examine the scrotum.  In order to confirm the diagnosis an ultrasound scan of the area may be recommended.  The majority of varicocoeles are small and do not produce symptoms. In these cases treatment is not usually required. However, treatment may be recommended if the varicocoele: 

  • Produces unpleasant symptoms
  • Looks particularly unsightly
  • Affects fertility
  • Impairs the growth of the testicle (this is particularly important in children and adolescents)

Treatment 

Anti-inflammatory medications may be prescribed to help reduce any discomfort caused by the varicocoele and the wearing of snug, supportive underpants may be suggested.

Surgical treatment involves tying off (ligating) the affected vein so that blood is redirected into other, healthy veins. The two different surgical techniques used to achieve this are open surgery and laparoscopic surgery.  Both have similar success rates but laparoscopic surgery tends to have a quicker recovery time. Both types of surgery are performed on a day-stay basis under a general anaesthetic.

Another treatment technique is varicocoele embolisation. This non-surgical technique is performed by an interventional radiologist (specialist x-ray doctor). It involves making a small incision in a vein in the groin or neck and uses x-ray guidance to thread a thin tube (catheter) into the varicocoele. A small metal coil is threaded through the tube into the affected vein. The coil blocks blood flow to the bad vein and redirects it to other, healthy veins. Sometimes a special solution to block off the vein may be used instead of a coil.

Varicocoele embolisation has a quick recovery time and has the advantage of not requiring a general anaesthetic.

References

Brayden, R. (2006) Varicocele. In Clinical Reference Systems. McKesson Health Solutions. Thomson Gale.
Figeuroa, T.E. (2011) Varicocele. In KidsHealth - TeensHealth. Nemours Foundation. http://www.kidshealth.org/teen/sexual_health/guys/varicocele.html
O'Toole, M.T. (Ed.) (2013) Mosby's Dictionary of Medicine, Nursing & Health Professionals. (9th ed.) St.Louis: Elsevier Mosby
 
Last Reviewed – 29 April 2013
 
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