What is Varicocele ?
Varicoceles are dilated blood vessels in the scrotum. They are usually asymptomatic, although they may cause pain or a heavy sensation in the scrotum, and they may contribute to infertility Diagnosis is by clinical examination. The cardinal sign is a scrotal mass that feels like a bag of worms. No treatment is required, but surgical intervention is required to manage symptomatic varicoceleFollowing surgical intervention the complete resolution of the varicocele implies a favorable prognosis, although it is not clear whether surgery improves fertility
Tibbislami Dwakhana and Varicocele ?
- An abnormal dilation of the spermatic venous or pampiniform plexus of the testicle
- Presents as a scrotal mass that feels like a bag of worms
- Usually unilateral and involving the left testicle, but can be right-sided only or bilateral
- When supine, there is less distention of the mass than on standing
- When the patient performs the Valsalva maneuver, the distention increases
- Usually asymptomatic
- Commonly found as an incidental finding as part of infertility investigations
- Most clinically insignificant varicoceles require no treatment
- Varicocele is commonIncidence increases with age until adulthoodPresent in 15,000 of 100,000 adult men
- Present in 40,000 of 100,000 men with decreased fertility
- Prevalence varies with age. Varicocele is much more common at adolescence and into adulthoodBilateral involvement is very unusual under 11 years of age. After 11 years of age, 100 of 1,000 cases may be bilateral800 of 100,000 boys aged 2 to 6
- 1,000 of 100,000 boys aged 7 to 10
- 7,800 of 100,000 boys aged 11 to 14
- 15,000 of 100,000 boys aged older than 15
Most varicoceles are asymptomatic. However, they can be uncomfortable and cause scrotal pain. This pain is generally mild to moderate, occurs with long periods of sitting, standing or activity and is relieved by lying down. Although it can be uncomfortable before bedtime (after a long day of activity), it generally does not occur upon awakening after a night’s rest. The pain is dull, congestive‚ “tooth ache” like and generally doesn’t refer elsewhere. It is not associated with urination issues or erectile dysfunction; however, it is associated with male infertility. Lastly, when large, a varicocele can cause a clumpy “bag of worms” feel in the scrotum and can be bothersome for this reason as well. Varicoceles and Male Fertility Approximately 35% of men in Dr. Turek’s practice who are evaluated for infertility will have a varicocele, a much higher rate than that found in the general population (15%).Over the last 50 years, this had led to the intensive study of the relationship between varicoceles and male infertility. The mechanism by which a varicocele on one side can affect the fertility of both testicles is not clearly understood. What is true is that the temperature of the scrotum is normally several degrees cooler than body temperature, which is important for normal sperm production and testis function. This temperature difference is carefully maintained by the normal anatomy of the scrotum. The dilated veins in a varicocele may decrease the effectiveness of this natural cooling mechanism and “overheat” the testis and reduce its ability to function. Exactly how heat affects sperm production . However, a leading theory suggests that increased oxidative stress reduces the fertility of varicocele patients. In addition, there is recent data that shows that sperm quality, can be elevated in men with varicoceles and that varicocele repair can significantly lower these rates. In any case, the semen analysis in varicocele patients can show impaired sperm numbers, movement or both. Varicocele Diagnosis
The “gold standard” way to diagnose varicoceles is by physical examination. With a patient in a standing position, palpation of the scrotum by a well-trained physician can reveal a varicocele. Exercise and prolonged standing may also demonstrate a varicocele. Difficulties palpating a varicocele arise when the scrotal wall is thick or contracted. In addition, benign fat, termed lipoma of the cord, can feel like a variocele. Unlike a varicocele, however, a lipoma will not go away when the patient lies down.