The scrotum is a sac that holds the testicles and contains the blood vessels that deliver blood to the male reproductive glands. A varicocele is formed when the veins inside the scrotum swell up and become enlarged. It is similar to getting varicose veins in your leg.
Varicoceles are common. They affect roughly 15% of male adults and 20% of adolescent males. These can form during puberty and are usually found on the left side of the scrotum. In some rare cases, varicoceles can also exist on both sides of the scrotum.
In general, the one-way valves in the veins of the scrotum move the deoxygenated blood from the testicles back to the heart. For a few people, this blood flow is hampered due to which blood tends to pool in the veins thus leading to excessive swelling. This is how a varicocele develops slowly over a period of time.
Varicoceles in teenage boys usually form due to their quick growth during puberty. Their testicles require more blood than normal during development and even a minor issue with the veins can prevent the desired blood flow thus leading to varicoceles.
As yet, there are no clear risk factors for varicoceles and its exact cause is also unclear.
Some patients do not have any prominent symptoms of varicoceles. For most other patients, varicoceles cause pain and discomfort and can lead to shrinkage of the testicles.
Patients often experience the discomfort to get worse while standing for prolonged periods or due to physical exertion. They usually experience relief from pain by lying down on the back.
In most cases, varicocele patients develop a lump in one of the testicles or swelling in the scrotum. They also develop visibly enlarged and twisted in the scrotum.
If not treated on time, varicoceles are lead to male infertility due to reduced sperm count and diminished motility of the sperms.
Asymptomatic varicoceles usually remain undiagnosed until they are discovered during fertility treatment or routine physical examination.
During medical check-up, varicoceles cannot always be felt when the patient is lying down and thus the doctor might ask you to stand up for the physical examination.
Doctors discuss the possibility of varicocele if they are able to notice that the testicles have shrunken in size or that the scrotum looks like a bag of worms due to the swollen and enlarged veins.
To confirm their diagnosis, doctors check for unusual blood flow with a non-invasive imaging examination called the colour doppler scan. Doctors may also recommend a venogram which is a radiograph that injects special dyes in the blood vessels to check for any abnormalities in blood flow.
Asymptomatic varicoceles do not require treatment. But if you have pain, discomfort, or experience any other symptoms, you must consult your doctor for medical treatment.
Catheter-directed embolization or varicocele embolization is the best non-surgical and minimally invasive treatment for varicoceles. This procedure is performed under the influence of local anaesthesia.
The doctor (interventional radiologist) inserts a catheter from a tiny incision on the skin and injects sclerosants in the damaged veins. The abnormal veins are blocked and blood supply is restricted. This causes these damaged veins to shrink and die.
The body automatically re-routes the blood flow to other veins and the patient gets relief from the swelling and pain in the scrotum. It is a safe procedure and does not have any major side-effects.