What is Varicocoele

Varicocoele is a disease of the testis- namely the pampiniform plexus of veins (the network of veins that drain blood from the testes). Recall the testes are the male gonads responsible for sex hormone and sperm production.

The condition occurs due to an incompetence of the valves within the veins of the spermatic cord. This causes the veins to expand, resulting in a localised venous lump (or varicocoele) near the testis. It is much more common on the left thought to be due to the anatomical relationships of the veins.

Statistics on Varicocoele

Varicoceles are common occuring in around 8% of Australian adult males. However, the true incidence is not known as the condition tends to be assymptomatic. It can affect virtually any male but commonly presents in adolescence and may be more common in tall, thin men and those from hot climates. Varicocoele is the most common cause of male infertility but up to two thirds of men suffering the condition will maintain their fertility.

Risk Factors for Varicocoele

As forementioned, varicocoele more commonly affects the left testicle and is thought to be due to incometent or inadequate valves in the spermatic cord leading to a pooling of blood within the pampiniform plexus. There may be som genetic factor predisposing to the condition as it can run in families. Occassionally a varicocoele can develop suddenly due to a tumour in the kidney which obstructs the renal vein. This is more likely in elderly men.

Progression of Varicocoele

In the majority of cases, patient with this disorder will never experience symptoms or complications because of it. The varicocoele is normally present from early childhood, as the defective valves within the pampiniform plexus of veins around the testis slowly allow the formation of a varicocoele. This may not be noticeable until puberty when blood flow to the testes increases. The condition may result in pain and noticeable swelling by the patient or, more importantly, reduce the quantity and quality of sperm produced by the underlying testis. This may result in the development of infertility. The ocndition may be treated surgically, with many patients experiencing a return to normal fertility following treatment.

Symptoms of Varicocoele

In the majority of cases, patients do not have symptoms from this disorder. You may notice a lump or swelling on or above one of your testicles whilst standing. A dragging sensation may also be present which may be worse following exercise or in hot weather. You may also find you and your partner have problems becoming pregnant.

Clinical Examination of Varicocoele

Your doctor will careful examine your testicles by looking and feeling. This should be done whilst you are standing as a varicocoele can disappear when you lie flat. The characteristic feeling of a varicocoele is like a “bag of worms.” Your doctor may ask you to cough which increases the blood flow to this area and makes a varicocoele easier to detect. They may also measure the temperature with a special device as varicocoeles are thought to increase the temperature of the testicles.

How is Varicocoele Diagnosed?

Varicocoele may appear similar to other conditions of the testis, especially when painful. To exclude these other conditions, blood and urine samples may need to be taken. Your doctor will also perform imaging of the testes using a standard or colour Doppler ultrasound. This allows the swelling to be visualised and can be important to rule out other conditions such as tumours in the kidney.

Prognosis of Varicocoele

The prognosis of varicocele remains controversial. It may not require treatment if you have no symtoms and do not have any fertility problems. However, the condition may be treated with a minor operation, which will normally lead to the resolution of symptoms of pain and swelling around the testis, after recovery from the procedure. The exact rates of fertility of recovery are contraversial, however, good response rates have been demonstrated by a number of studies.

How is Varicocoele Treated?

Treatment of this condition is only required when:

  • Your symptoms become intolerable.

 

  • You and your partner are unable to concieve, despite long-term attempts.Conservative treatments such as testicular supports (tight fitting underwear and jockstraps) may be tried initially. However if symptoms or problems persist, surgery is the usual form of treatment as no medical therapies have shown to be of benefit.The surgery performed is referred to as varicocectomy. In the procedure, a small incision is made into the scrotum and the distended veins are removed surgically. This procedure may be done as an open procedure or with the use of keyhole surgery (laparoscopy). The surgery is quite simple and has good response rates of at least 80%. Another possible technique used is embolisation of the testicular veins via the femoral vein in the thigh.

    Varicocoele References

    1. Burkitt, Quick. Essential Surgery. 3rd Edition.Churchill Livingstone. 2002.
    2. Kim ED, Varicocele, eMedicine, Web MD, 2006. Available [online] from URL: http://www.emedicine.com/med/topic2757.htm
    3. Kim ED, Leibman BB, Grinblat DM, Lipshultz LI. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol. 1999 Sep;162(3 Pt 1):737-40.
  • Murtagh J, Varicocele, Australian Doctor. Available [online] at URL: http://www.australiandoctor.com.au/patient/020301_varicocele.pdf.
  • Sandlow J, Pathogenesis and treatment of varicoceles, BMJ 2004;328:967-968.