About Varicocele
A varicocele is a collection of swollen veins in the scrotum. Sometimes, varicoceles are painful, especially when a man bears down to lift heavy objects or is standing up for the majority of a day. Varicoceles form due to faulty valves in the testicular veins, resulting in a pooling of blood in these veins. Tall men have a higher incidence of varicocele because the distance from their heart to their scrotum is longer.
1-3
How doctors grade the severity of varicoceles with grade three being visible noticeable.
2-3 week
Full recovery time for microsurgical subinguinal varicocelectomy, a treatment of varicoceles.
Signs and Symptoms of Varicoceles
Varicoceles aren’t explicitly dangerous, but there are 3 problems they can cause for men.
Pain
classically this is a dull, achy type pain felt in one side of the scrotum
Fertility problems
Varicocele is the leading cause of male infertility. Sperm like to be a couple degrees colder than the rest of the body; that’s why men have scrotums, to keep their testicles away from body heat. As any guy knows, when his scrotum is hot, it hangs much lower than when it is cold. If a man has a varicocele, the sperm will be closer to body temperature at all times. This heat can cause the sperm to lose the ability to swim fast (motility defect) can can even interfere with production and shape (morphology) of sperm.
Problems with Global testicular function
Varicoceles can prevent normal testicular growth and proper production of testosterone, leading to hormone imbalances and small testicles.
Doctors grade varicoceles on a scale of 1 to 3. The grade of varicocele does not reliably predict the severity of a man’s symptoms or defects in his sperm quality, though grade 3 varicoceles are visibly noticeable.
Treatment Options for Varicoceles
Varicoceles can be fixed in a variety of ways – radiological embolization, laparoscopic surgery (through the abdomen), inguinal, and subinguinal approaches. The technique with the lowest complication rate and lowest chance of recurrence is the microsurgical, subinguinal varicocelectomy, which is performed under a high-powered operating microscope. This technique requires specialized fellowship training to master and is the technique that I prefer. The surgery is done under general anesthesia (fully asleep) and takes about 30-45 minutes per side. The incision is roughly 1 inch long and located in the lower groin. Once the spermatic cord is exposed, the abnormal veins are encountered and each vein is meticulously dissected and then tied off to disrupt flow and provide drainage of blood away from the testicle into the inner thigh and pelvis. Arteries, lymphatic drainage, and the vas deferens are left intact. If an artery is cut, damage to the testicle can occur. If the vas deferens is injured, sperm can be blocked. If lymphatics are cut, the scrotum can fill with fluid and require additional surgery to drain the fluid. The microsurgical approach has been statistically shown to reduce all of these risks. This procedure is performed as a same-day surgery without need for a hospital stay. Recovery to full activity is usually between 2-3 weeks but most men are able to return to a sedentary job in 48-72 hours.