Varicose veins are usually associated with ladies who have laboured from standing and giving birth over the years. Men can also suffer from the same condition but in a less conspicuous location in the scrotum.
The scrotum is a bag that contains the testes and is located right beneath the penis. Varicocele is a common condition seen in about 15% of men. Many patients present to me with a history of a ‘heavy’ or ‘pulling’ sensation that has been gradually worsening over years or months. The patient commonly complains of a lump of stringy stuff above or around the testes. Dr Google usually describes them as a “bag of worms” sensation.
Varicoceles occur due to abnormal valves in the veins, the same way as varicose veins in ladies, which leads to blood pooling. Imagine pumping water to the top of the building’s water tank. If the pump fails, the water pools in the basement, leading to high pressure in the pipes. In a varicocele, the venous blood pump is pumped upwards toward the heart and pools inside these veins, leading to engorged veins. The veins in that region are interconnected like a spider web, which increases pressure on the remaining web and causes more damage to the other veins. Over time, the web of veins becomes more extensive and causes more problems.
The leading causes of these conditions are varied. People tend to tell me different causes, mainly related to increased abdominal pressure. Abdominal pressure occurs when you contract your core muscles during the day. Weightlifting, crunches, chronic cough, and constipation are some of the usual long triggers of varicocele. Another common cause of varicocele is low-impact repetitive trauma, most seen in running without supportive underwear.
If you think you may be presenting symptoms of Varicocele, schedule a consult as soon as possible.
There are many ways of classifying varicocele, but European guidelines grade varicocele subclinical + Grade 1-3, with grade 3 being the worst.
Apart from the discomfort, varicocele can impact a man’s fertility. There is substantial medical evidence that shows the varicocele impairs sperm production. The testes rest outside most male mammals as testes must be cooler than the core body temperature. In humans, it is around 1.7 degrees lower than body temperature for the testes to function correctly. Blood pooling around the testes raises the temperature and leads to decreased sperm production and, if persistent, testicular atrophy or shrinkage. Varicocele, hence, is the most common operation that is performed for male infertility.
Infertility is when you fail to achieve pregnancy after 12 months of unprotected sex. There are exceptions to this rule in the investigation for infertility when the potential mother is above 35 years of age or if the potential father has related medical issues with the testes. In this situation, an investigation can begin after six months of trying.
Your doctor requires 1-2 semen (sperm) analysis to understand your sperm parameters. There are many numbers in a semen analysis, but urologists look at 3 major parameters: the Number, Shape and Mobility of the semen sample. It is important to note that not all varicocele needs surgery. This is particularly true if you have subclinical varicocele (only seen in Ultrasound) or if you have normal semen parameters in your sperm analysis. 40-70% of patients improve their semen parameters after surgery, although it is unclear if this led to successful pregnancies.
Apart from infertility, varicocelectomy can be performed for patients who have significant discomfort from the constant pulling or dragging sensation. Serial surveillance of the testes is also essential to look for testicular atrophy, even if parameters are normal. If there is a significant volume difference between the left and the right testes or you have bilateral palpable varicoceles, then surgery may be indicated even with normal semen parameters. This is particularly important that catch-up growth occurs in adolescence if treated early.
There are many ways to treat this condition, broadly classified into surgery and embolisation. Surgery is the most common approach due to its effectiveness and safety in well-trained hands. Varicocelectomy is a day procedure and involves a small 2-3cm incision above the groin region. There are many surgical approaches to varicocelectomy, including open, laparoscopic, inguinal, and sub-inguinal, with or without microsurgery.
The microsurgery sub-inguinal approach shows the best clinical results regarding complications. The main complications of this procedure are hydrocele of up to 10% in open cases and <1% in microsurgery. Testicular atrophy (1-5%) can also occur from injury to the testicular artery, which can be very tiny. After the surgery, minimising the risk factor that causes varicocele is vital so that recurrence does not recur.
Infertility is an important issues for many couples. Research has shown that the male is responsible for infertility half of the time and thus investigation will be required for both man and woman. As doctor, I am particularly appreciative when the couple are present for the consult to have an open and meaningful consultant. If you have a varicocele or have trouble conceiving, seek help and do not delay.
If you think you may be presenting symptoms of Varicocele, schedule a consult as soon as possible.
Our friendly team is looking forward to serving you. For urgent enquiries and appointment requests, please call the clinic directly.
Dr Jay Lim is a urologist with a focus on providing personalised treatment plans specific to your unique urinary and reproductive health needs.
Share this website
