Varicocele (bilateral): what it is, symptoms and treatment

Varicocele is a condition responsible for the dilation of testicular veins.

In some cases, sperm production may be impaired, causing infertility in some men.

Check out the article below to answer all your questions about varicocele!

What is varicocele?

Varicocele, or varicose veins of the testis, is a condition that causes the dilation of the pampiniform plexus veins, that is, the pouch below the penis, where the testicles are located.

This condition can be understood as an insufficiency in the drainage of blood from the testicles , which consequently causes an increase in the volume of the veins present inside the scrotum.

Its incidence occurs mainly from adolescence to adulthood, from 15 to 25 years old.

In general, varicocele is asymptomatic and can be seen through self-examination or by increasing testicular temperature.

About 15% of men develop the condition, which is the main cause of infertility among males. However, it is important to note that varicocele does not always indicate sterility , but it can cause it.

The dilation of the spermatic cord veins can hinder venous return, causing testicular dysfunction and, as a result, worsening semen quality.

This condition can be classified into 3 degrees, which differ by size and appearance. In the mildest cases, the dilation is only apparent through physical effort.

Treatment is generally not necessary, only in cases of discomfort, pain or infertility.

In ICD-10, varicocele is found by code I86.1.

What is bilateral varicocele?

Varicocele is a condition that, in most cases (95%), presents only on the left side.

This is because the vein on the right side flows into the vena cava through an angle of 45º, which ends up facilitating the flow of blood.

On the other hand, in the vein on the left side, this angle is 90º, making it difficult for blood to pass.

When the dilation reaches both sides, the varicocele is called bilateral.

Varicocele degrees

Based on the degree of development of each case, the doctor will be able to classify varicocele in 3 ways:

Grade 1

It happens when there are small changes, which are not visible or palpable when the patient is standing. In these cases, it is possible to identify the condition only through exams.

Grade 2

Moderate, grade 2 varicocele is also not visible to the naked eye. However, it ends up being easily detected and palpable without the aid of clinical examination.

When making some physical effort, the patient may experience mild pain and heaviness in the scrotum region.

Grade 3

In the most evolved case, there are major changes that can be easily detected, even without effort and in a relaxed posture. Men with grade 3 varicocele may experience fertility problems.

Causes

Varicocele can be understood as a genetic condition developed due to deficiency of the testicular vein valves. Once the blood accumulates in the testicles, the pressure ends up causing the veins to dilate and, consequently, the varicose veins.

In addition, poor blood circulation causes an increase in the temperature of the scrotal sac, impairing the production of sperm.

Risk factors

One of the risk factors related to varicocele is age – the incidence is higher among men aged 15 to 25 years.

Some recent research associates varicocele with factors such as being overweight and smoking . However, there is no proven relationship yet.

Another possible risk factor, also unproven, is the relationship between varicocele and kidney tumors, which can block blood flow and, consequently, cause varicose veins.

Symptoms

Varicocele is known to be an asymptomatic condition, that is, it usually has no symptoms. However, there are ways to identify varicocele, among which we can mention:

Changes in the size, shape or appearance of the testicles

This symptom occurs precisely due to the appearance of varicose veins present in the testicles. These end up causing a change in the appearance of the testicles.

Pain when standing or practicing physical activities

The strength required to perform a physical activity increases the pressure in the abdomen, which as a consequence causes dilation of the testicular veins, causing pain and discomfort.

Scrotal swelling

The dilation, caused by the impounded blood, causes a swelling in the scrotum region. It is worth remembering that varicocele can affect both testicles, however, it is more common to occur on the left side.

How is the diagnosis made?

 

The diagnosis of varicocele can be made by the patient himself, through palpation of the testicles, in order to identify swelling, pain, or possible changes in the region.

However, it is necessary to consult a general practitioner or urologist in order to confirm the condition.

For this, the doctor may find it necessary to perform the valsalva maneuver , which consists of exhaling the air with the mouth and the nose closed, being able to cover them with the thumb.

This process can be performed as a diagnostic aid, in order to identify the increase in volume in the affected region.

In addition to this, there are other tests to diagnose varicocele, such as Doppler ultrasound, which aims to assess local blood flow.

Does varicocele have a cure?

Yes. However, in most cases it is not necessary to carry out the treatment, only in cases that cause pain, local discomfort and infertility for at least 2 years.

What is the treatment?

Varicocele is considered the major cause of male infertility, requiring specific treatment when requested by the urologist.

The treatment of varicocele is surgical and has a chance of improvement in up to 75% of cases.

In addition, the treatment improves the intrinsic quality of the sperm cells, providing a better performance for reproduction and pregnancy, if it is the couple’s option.

Surgery

The surgical procedure aims to seal the affected vein in order to direct blood flow to veins that are in good condition.

Know the main surgeries indicated for varicocele:

Open surgery

This is considered the simplest procedure, in which the patient usually receives local anesthesia and can leave the hospital the next day.

It is recommended to use a testicle support for a few days, in addition to not being able to make physical effort between 2 to 4 weeks after the procedure.

Laparoscopic surgery

This procedure is more complex, since its duration is longer, as well as the hospital stay. However, the difference of this surgery is in the incision, which in this case ends up being smaller than the others.

Embolization

Non-surgical procedure, in which anesthesia is not necessary and its duration ends up being shorter than the others. It is considered a new technique, not yet widely adhered to by urologists.

Living together

 

It is possible to look for alternatives to alleviate the discomfort caused by varicocele, such as:

Use scrotal braces

This accessory offers protection and support for the testicles, reducing tension and local pain. It has an anatomical shape and can be adjusted with an elastic band.

Maintain healthy habits

Some recommendations regarding male health involve adhering to healthy habits, such as maintaining a good diet, practicing physical activities, controlling stress symptoms and not smoking.

Prognosis

Men who have varicocele have good prospects for improvement. Depending on the development of the condition, surgery becomes the best option to increase fertility, being a safe method of treatment.

In addition, people who effectively perform the surgical procedure increase the average amount of sperm in the body by an average of 5 times. Consequently, there is less chance of developing infertility.

Complications

In some cases, varicocele can leave sequelae in the male organism, such as atrophy, or shrinkage of the testicles.

This is because the organs responsible for the production of sperm (tubules) are damaged in the presence of this condition. As a consequence, the testicle gets smaller.

Varicocele and infertility

 

Infertility is a possible consequence of varicocele.

Due to the dilation of the veins, there is an increase in the local temperature of the scrotum. However, the testicles must always be 1 ºC below body temperature, which is why they are “separated” from the body.

As a consequence of this increase in temperature, the production of sperm is impaired, thus causing a change in the amount of sperm.

Therefore, in some cases, it may be that the man will develop infertility.

How to prevent varicocele?

Varicocele is a condition that cannot be prevented. However, doctors stress the importance of men seeking medical attention at the first sign of varicocele development.

This will prevent the progression of the condition and consequently, the possible complications.

Common questions

Who has varicocele can have children?

It depends. Most men who have the condition and seek treatment early can return to being fertile. However, among infertile men, 45% are due to varicocele.

Does varicocele correction improve the spermogram and correct infertility?

In most cases, yes. Infertility is a multifactorial condition, that is, varicocele correction does not necessarily act directly on this aspect. The ideal is to seek a urologist in advance, in order to perform a spermogram and identify the need or not for treatments.

What is the resting time after varicocele surgery?

This is relative. It will depend a lot on the type of surgery you seek and the opinion of your urologist. However, the consensus is between 2 to 3 days so that it is possible to return to the usual activities. It is important to note that during the first 7 days it is recommended to work sitting.

Is it normal to have veins in the testicles?

The structural configuration of the testicles is composed of veins, arteries, epididymis and the vas deferens. However, some conditions can cause changes in appearance, such as the appearance of local swelling. This occurs more frequently in the left testicle, which may have other symptoms, such as discomfort.

When does varicocele need to be treated?

Varicocele treatment is generally not necessary, only in cases of local discomfort, pain and proven infertility for more than 2 consecutive years.

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