In other words, varicocele are dilated veins of pampiniformis plexus, which under normal conditions deal with venous blood return from the scrotum. In case of pathology, this mechanism is reversed. Then, its congestion is reported due to blood stasis in dilated venous plexus. It affects negatively spermatogenesis. Thus, varicocele are considered to be the cause of male infertility which may be the most frequently corrected condition.
The first surgical procedure of the management of varicocele was performed in 1952 by Tulloch. The most recent approach to the treatment of this condition consists in percutaneous intravascular embolization ending with the closure of testicular vein and pampiniformis plexus vessels.
Are varicocele a prevalent social problem?
It is assumed that varicocele affect nearly 10-15% of male population. It is estimated that in males with confirmed infertility, the frequency of this disease is almost 30-40%.
What is the most common reason of varicocele?
Varicocele are classified into primary and secondary. The first group substantially predominates over the latter. It is an effect of congenital dysfunction of left testicular vein (most frequently due to defects in valves), their poor placement or lack of them. Having large varicose veins in the region of left scrotum usually leads to developing disorders of venous flow from right spermatic cord. Impaired venous blood outflow from testicles and epididymis results in deficient spermatogenesis.
The most common deviation in patients with varicocele is impaired mobility of spermatozoa and decrease in their count to < 20 million/ml (WHO data). The reasons of the secondary increase of the tension in pampiniformis plexus of the spermatic cord are observed in various compression syndromes, leading to the compression of testicular veins, e.g. in the course of lymphoma, the nutcracker syndrome or abdominal aortic aneurysm.
What are the symptoms of varicocele?
A number of patients with slight varicocele do not experience serious symptoms. In case of large varicocele, patients suffer from heaviness in the scrotum and swelling. Long-term venous stasis may lead to a decreased volume of scrotum and infertility. From our every day practice transpires that with advanced varicocele, more frequently bilateral ones, atypical varicose vein appear on legs. In such cases, a precise analysis of venous leakages from the scrotum to the extremities is required prior to the initiation of adequate treatment of leg varicose veins.
How are the varicocele diagnosed nowadays?
Depending on the clinical advancement, varicocele are classified into 3 grades:
- Grade I: palpable exclusively with Valsalva maneuver.
- Grade II: palpable while standing at normal breathing.
- Grade III: visible through the scrotum skin.
Ultrasound of the scrotum with evaluation of venous blood flow is the method of choice in the diagnostics of varicocele. In Phlebology Clinic, we always perform evaluation of flows and diameter of testicular veins via abdominal examination. In case of any doubts, prior to the planned surgical procedure or intravascular embolization, we always perform additional examinations: venography of abdominal cavity veins and small pelvis using computed tomography (CTV) or resonance imaging (MRV).
How does the treatment of varicocele look like?
Decision on the treatment of varicocele in males is undertaken in case of symptomatic stage of the disease, confirmed dysfunctions of semen composition (oligozoospermia) and male infertility. An additional indication are large atypical varicose veins on legs, whose healing is dependent on the elimination of venous leakage from the varicose veins of the scrotum.
Different techniques are employed in treatment. Currently, classic methods are replaced by laparoscopy (performed in the Sports Medicine Center) and intravascular embolization via percutaneous access, which is the least invasive method of varicocele treatment.
The latter method consists in the embolization of insufficient testicular vein with spirals with simultaneous sclerotization of descending varicose veins to the scrotum. [picture]
Embolization of varicocele is performed in the hemodynamic unit of the Medicover Hospital in Warsaw. All procedures are performed under the guidance of ultrasound transducer and with the use of digital angiography devices. Venous embolization procedures are made within 4-6 hours admission to hospital, usually without a need for general anaesthesia. With the full assistance of anaesthesiologist, patient is introduced to shallow sedation. Thus, there is a contact with the patient throughout the procedure.
Information to remember:
- the majority of varicocele is localized on the left side, right-side varicose veins appear most frequently as secondary to the left-side lesions
- inhibition of varicocele is aimed at decreasing the temperature of testicles, thus, it has to improve the physiology of the spermatozoa
- the quality of semen is improved following the repairing procedure of varicocele exclusively in some patients
- in case of secondary varicocele (appearing at older age), other conditions should be excluded such as cirrhosis, neoplasm in abdominal cavity or small pelvis or heart failure