A varicocele is a swelling of the veins in the scrotum (scrotum). Varicoceles occur in the scrotum which serves to hold the testicles and contains arteries and veins in the sperm duct (spermatic cord) in each testicle above the scrotum. The veins that carry blood from the testes to the penis should not be palpated or felt, but when a varicocele occurs they look like many worms in the scrotum. This condition is similar to varicose veins in the legs.
Varicoceles can form around the age of 15 to 25 years, and are mostly found in the left scrotum. However, varicoceles can still occur on both sides of the scrotum. Varicoceles often do not cause symptoms and are not life threatening, but they can cause the testicles to shrink, which can interfere with fertility. Varicocele cases that cause symptoms or result in infertility in patients can be treated with surgery.
Symptoms of Varicocele
Varicoceles usually do not cause symptoms. However, in some patients, this disease can cause complaints:
- Discomfort in the scrotum.
- Pain that increases when standing or doing physical activity for a long time, and decreases when lying down.
- A lump in one of the testicles.
- The scrotum becomes swollen.
- Over time, the enlarged veins will look like worms in the scrotum.
Causes of Varicocele
Most cases of varicocele occur because the valves of the veins are not functioning properly. Along the veins, there are one-way valves that open blood flow to the heart and close immediately when blood flow slows down. A varicocele occurs when the valve cannot close properly so that blood flow reverses and collects in the area before the valve was damaged, forming a varicocele. However, it is unclear what causes the valves of the veins to not function properly.
A varicocele can also occur when the larger blood vessels in the abdomen become blocked, allowing blood to collect in small veins, such as the scrotum, causing them to widen. However, this condition is more common in men over 40 years of age. This condition can be caused by various conditions, for example the growth of a tumor in the kidney that presses on a vein.
Varicocele Diagnosis
The diagnosis of varicocele begins with a physical examination to determine the patient's condition. The examination is by feeling for a varicocele which is characterized by a hard mass above the testicle and feels like a worm. The doctor may also ask the patient to perform exhalation movements with the mouth and nose closed to clarify enlarged veins.
To confirm and find the cause, the urologist may suggest a series of investigations, including:
- Scrotal ultrasound. This examination aims to see the size of blood vessels and blood flow in detail.
- Testicular volume measurement. An instrument for measuring testicular volume is called an orchidometer.
- Sperm check. This examination is done to see fertility.
Varicocele Treatment
Most cases of varicocele are asymptomatic and do not cause any harm, so no treatment is needed. When a varicocele causes pain, the doctor can treat it with pain relievers, such as ibuprofen or paracetamol, to reduce pain. In addition, the doctor may ask the patient to wear testicular support pants to relieve pressure.
Meanwhile, varicoceles that cause severe pain or shrinkage of the testicles, as well as infertility in men, will be treated. Some ways that can be done:
- Embolization.Embolization is done by inserting a tube to reach the vein where the varicocele is located through the groin or neck. The doctor will insert a substance to improve blood flow and varicocele. Embolization is performed under general anesthesia and the procedure takes several hours.
- Operation.The doctor will pinch or tie the blood vessels that become varicoceles to block blood flow to these vessels and can flow to other normal blood vessels. The operation can be done with open surgery or minimal incision techniques with the help of a special tool called a laparoscope. The operation can be performed under local or general anesthesia.
The post-operative healing process is 1-2 days, however, patients need to avoid strenuous activities for 10 to 14 days. In addition, a follow-up examination by a urologist also needs to be carried out for 3 to 4 months, especially for patients with varicoceles who are accompanied by infertility.
Varicocele Complications
Complications that can arise in patients with varicocele include:
- Shrink it testes.Damaged venous valves can cause blood to collect and press on the vein continuously, increasing the risk of exposure to toxins in the blood. This condition results in testicular damage, including shrinkage of the testicle.
- infertility.Varicoceles keep the temperature around the testicles high, which can interfere with the formation, function, or movement of sperm.