Varicocele

Varicose veins are not only found in the legs: if they occur in the scrotum, they are known as varicoceles.

Varicoceles form in the veins that run along the spermatic cord. This carries the blood from the testicles back into the body. Similarly to other varicose veins, varicoceles form when a build-up of blood in the veins causes them to become permanently enlarged.

In most cases, varicoceles have no direct symptoms whatsoever. Sometimes though, they can cause swelling, a feeling of tightness or a dull, “dragging” pain in the scrotum.

A varicocele can also affect fertility and may sometimes prevent men from having children. However, this is not always the case and many men remain fertile despite having a varicocele.

The veins in the scrotum can become enlarged for a number of reasons. These can be linked to individual physical conditions: in some men, the testicular vein joins the renal vein almost at a right angle in the pelvis. This slows the blood flow, potentially causing a build-up of blood in the scrotum and resulting in a varicocele.

As unfavorable join angles are generally found more often on the left-hand side, varicoceles are also more common on this side. In some cases, varicoceles can also be caused by a congenital weakness of the vein wall. Like with other varicose veins, the same applies to weakened venous valves.

If a tumor presses against the veins and prevents the blood from flowing properly, this can also cause a varicose vein in the scrotum. This situation is very rare though. If it does occur, experts refer to the condition as a “symptomatic” varicocele to distinguish it from a “normal” varicocele.

Varicoceles are most commonly recorded in teenagers and young men between the ages of 15 and 25. According to estimates, they affect 5 to 15 percent of all men.

In about 90 percent of those affected, the varicocele forms in the left half of the scrotum.

If varicoceles are large, doctors are able to directly see or feel them. Sometimes, however, they have to press on the stomach during an examination to fill the varicose vein with blood so that they can feel it. An ultrasound examination (sonography) is needed to detect smaller varicoceles.

In most cases, varicoceles do not need to be treated. If, however, they are affecting the fertility of a man who is unable to have children, the doctor may suggest treatment.

The affected vein is shut down so that the blood can flow through neighboring healthy veins. There are three methods for doing this:

• embolization
• sclerotherapy
• surgery

The vein is blocked (embolized) using medication or special little metal coils. These are inserted into the vein via a catheter and cause a blood clot to form in the varicose vein, closing it off.

Sclerotherapy follows a similar approach: a drug attacks the blood vessel wall causing the vein to stick together.

If surgery is performed, the doctor clips or ties off the swollen vein and the surrounding smaller veins. This is done using “open” surgery via a larger cut, for example in the scrotum or groin.

Varicocele treatment can also lead to complications, including bleeding, infected wounds, nerve injury or swelling in the scrotum known as a hydrocele.

Further information, for example on the question if treatment of a varicocele improves fertility, can be found at gesundheitsinformation.de.