Varicocele — Treatment Of Varicose Veins In The Testicle

Varicocele (VCL) is the varicose dilation of the veins of the testicular cord, the so-called pampiniform plexus. In other words, it is the presence of varicose veins in the cord of the testicle.

90% of varicocele cases (VCL) are in the left testicle. Bilaterality affects only 7% and only 3% on the right side. The varicocele in children is rare below 10 years. In these cases, we speak of prepubertal varicocele. The incidence of varicocele increases as we approach puberty and adolescence.

The biggest problem a varicocele can cause is its ability to affect fertility in men. In 40% of infertile patients, the cause is a varicocele. However, it never produces erectile dysfunction and this is important to highlight to avoid erectile dysfunction of psychological cause.

Causes of varicocele

The exact causes of the presence of varicose veins in the testicle cord are not known, however, it is attributed to several factors:

Anatomical causes.

The veins on the left side lead to the left renal vein, which is much higher than those on the right side. This causes a worse return of blood from the veins on the left side. That in turn causes them to dilate.

Genetic motives.

Some people are known to be born with a predisposition for the valves in their veins to behave incompetently. Therefore, it is not uncommon for patients with VCL to also present: varicose veins in the legs and hemorrhoids.

Presence of a tumor.

Lastly, and exceptionally, a varicocele may be due to the presence of a kidney tumor or in the retroperitoneum. In these cases, the tumor mass compresses the renal vein or the gonadal vein. On the other hand, the presentation of LCV is usually abrupt and patients are usually over 40 years of age. When it is, we use the term secondary varicocele.

Main symptoms

Usually, varicose veins of the testicular cord are asymptomatic. However, in young men, they can cause some discomfort, such as a feeling of heaviness after doing physical exercise.

In most cases, the patient accidentally discovers a lump in the left hemiscrotum. The most frequent symptoms of VCL, within its mildness, are:

Feeling of heaviness or discomfort in that testicle. It is usually a symptom in young men and in varicoceles secondary to tumors in men over 40 years of age.

Testicular pain of variable intensity. It is usually triggered, in adolescents and young men, after intense physical exercise and is relieved at rest. In adult men, pain is rare. When it happens, we must do an abdominal ultrasound to rule out renal and retroperitoneal tumors.

The sensation of heat in the scrotum.

Bulging of the cord. The bulge is not painful on palpation and is easier to identify in a standing position than lying down. In addition, it is more pronounced with Valsalva maneuvers (maneuvers that consist of increasing intra-abdominal pressure). This detail is important, since sometimes the patient is examined lying down or in a cold room, and goes unnoticed.

The decrease in the size of this testicle and its consistency. It is a symptom that does not always occur.

Ways to treat varicocele

Surgical treatment

The surgical treatment of VCL is based on ligation of the spermatic vein. It is the most used technique. This treatment can be done through incisions at different heights. At a high and retroperitoneal or low level, such as the inguinal or sub-inguinal route.

To perform the intervention, usually, magnifying glasses of at least 4x magnification is used. The use of glasses allows us to clearly differentiate the different structures of the cord. By more easily seeing the artery and lymphatic vessels, the risks of complications are lower.

The intervention is performed under epidural anesthesia. Usually, patients are discharged in 4–6 hours, although it is necessary to continue with analgesic treatment in the following days. The incorporation to work, logically depends on the profession of the patient, rarely more than a week.

Non-surgical treatment

Venous occlusion (varicocele embolization)we. It is performed using interventional radiology techniques. To do this, a catheter is passed from the femoral vein to the spermatic vein. Once there, a small wire called a coil is released in order to form a thrombus and achieve occlusion of the veins.