VARICOCELE
What is Varicocele ?
Varicocele is a very common condition in young men. Usually it is of no consequence. It usually occurs on the left side of the scrotum and is detected as a swelling only when the patient stands. It is caused by distended veins which lie behind the testicle. If the veins were visible, they would look like varicose veins on the legs. Just like varicose veins, the swelling disappears when the patient lies down because the pressure within the veins is then lower. When the veins distend, they cause a dull ache in the scrotum towards the end of the day. It is extremely uncommon for the varicocele to be associated with any other serious condition, although there may be a relationship between varicocele and the development of infertility. How does Varicocele occur ?
Blood which circulates from the testicle travels only towards the heart. To do this, it must overcome gravity and travel uphill when a person is standing up. Veins have valves to maintain the proper direction of flow. When the valves are faulty or absent (a congenital phenomenon) veins become varicose (distended and tortuous) and this is the probable reason for varicocele. The other reason for distension of veins is a blockage in the case of varicocele this is a very rare cause. Treatment Involved
Most varicoceles do not require treatment. The urologist will satisfy himself and you of the diagnosis. He may arrange an ultrasound scan to ensure that there is no other cause of discomfort in the scrotum, the bag which contains the testicles. Occasionally a kidney ultrasound will be arranged, because kidney disorders can rarely produce a varicocele. Treatment will only be advised when the varicocele seems to be the cause of pain. Operative treatment is then usually recommended. This consists of tying sutures around the veins somewhere between the testicle and the lower abdomen. To do this, most urologists favour an operation where they enter the abdomen. This involves an incision in the groin similar in approach to a hernia repair. The operation can be performed as a day case, but a general anaesthetic is usual. At least one week away from work is advisable. Because the scrotum stretches muscle, some post-operative discomfort is to be expected. The stitches used will probably be of the dissolvable type. If not, they are usually removed 7 10 days later. In some hospitals, varicocele can be treated by a special x-ray technique performed under local anaesthetic. This is a complicated procedure in which an injection is made into the varicocele to block the veins. This is called embolization. In expert hands both procedures are equally successful. In some hospitals, laparoscopic, or keyhole surgery can be used to achieve the same result as the open operation. A general anaesthetic is required and the procedure can be performed as a day case. After treatment of Varicocele
Wound infection may occur after the surgical procedure, with redness and discharge. This should be notified to the specialist concerned, who may prescribe antibiotics. Bruising may occur at the site of injection after the x-ray procedure. This will settle after a few days. Long term there is a small incidence of hydrocele, a chronic swelling of fluid around the testicle. This does not usually need treatment. A small proportion of varicoceles recur, whatever the form of treatment. There should be no long-term complications of treatment of a varicocele. If the operation has been performed to increase fertility, an improvement in sperm count may not occur for 6 or 9 months. If Varicocele is left Untreated
A very few varicoceles continue to enlarge in size and therefore give discomfort. Usually the varicocele remains unchanged and does not require treatment. |
