Varicose veins are a common disorder that affects the blood vessels in the body. Among the most common types are varicose veins of the leg and esophagus, but varicose veins can also affect the veins in the spermatic cord, which plays an important role in nourishing the testicles. This condition can lead to a range of symptoms that may affect male fertility. In this article, Dalili Medical will discuss varicose veins, how to diagnose them, and the appropriate treatments for them.

**What is the difference between varicocele and varicocele?**

 

Varicocele occurs as a result of the inability of blood to flow properly within the spermatic cord, due to problems with the valves in the veins. This leads to blood pooling in the area preceding the valve, causing the veins to expand.

**How ​​can varicocele be identified?**

 

Yes, varicocele can cause veins to appear in the area.

**Function of the spermatic cord**

 

The spermatic cord consists of a pair of tubular structures that extend from the testicles to the inguinal rings. The spermatic cord is located within the male reproductive system, and works to support the testicles inside the scrotum. The spermatic cord contains many arteries, veins, and nerves, and its primary function is to transport sperm during ejaculation. The spermatic cord can also be exposed to many diseases, such as varicocele, which occurs as a result of the enlargement of the veins in the testicle, which may lead to pain.

**Causes of varicocele**

The main cause of varicocele is still not precisely determined, but it is believed that this condition occurs as a result of the enlargement of the blood vessels surrounding the spermatic cord, which transport blood from the testicles to the heart. This enlargement occurs due to a malfunction in the valves in these veins, which leads to blood pooling in them. This pooling may negatively affect the function of the spermatic cord, and the affected person may suffer from severe pain due to the pressure resulting from the accumulated blood. It is important to note that leaving varicocele untreated for long periods may lead to damage to the spermatic cord, which may cause infertility.

**Varicocele**

All men have a structure called the spermatic cord, which contains arteries, veins, nerves, and tubes that help transport blood to and from the testicles. Veins carry blood from the body to the heart, and a series of valves within these veins ensure that blood flows in one direction, preventing it from flowing backwards. In other words, these valves regulate the flow of blood and make sure it goes in the right direction. However, sometimes these valves can fail, causing some blood to flow in the opposite direction. As a result, blood can pool in the veins, causing them to expand and swell, which is known as varicocele.

**Varicocele Symptoms**

If you have pain in your spermatic cord or testicle, you may not notice any symptoms, depending on the severity of the condition. Sometimes, a man may not realize he has a varicocele. However, when symptoms do occur, they often occur in hot weather or after strenuous exercise, or when a man stands or sits for a long time.

Possible signs include:

- Mild pain in the testicle or testicles.

- A feeling of heaviness or pressure in the scrotum.

- Dilated veins in the scrotum that can be felt, often described as worm-like.

- Discomfort in the testicle or on the affected side of the scrotum.

You may also notice that one of the testicles appears smaller on the side where the dilated veins are located, due to the difference in blood flow.

**The difference between interventional radiology and traditional surgery**

 

When a man has varicocele, the veins responsible for transporting blood from the testicle become dilated. Varicocele is a common problem affecting men, and can lead to symptoms such as pain, discomfort, and decreased fertility. Therefore, varicocele treatment requires medical intervention to address this condition.

Traditional surgery is one of the available methods for treating varicocele, as it involves removing the dilated veins through a surgical procedure that requires an incision in the testicle. Although this procedure is considered effective in correcting varicoceles, it may be accompanied by several drawbacks and complications.

**How ​​are varicoceles diagnosed?**

 

Varicoceles are often discovered during routine physical examinations or during fertility evaluation. However, the patient may see a doctor if he feels severe pain, swelling in the scrotum, a lump in the scrotum, or a difference in the size of the testicles. In these cases, the doctor examines the testicles while the patient is lying on his back, and may need to perform the examination while the patient is standing, where he may feel pain or swelling.

What are the possible complications resulting from varicoceles?

 

In some rare cases, and when the varicoceles are severe, a group of complications can occur, such as testicular atrophy and infertility:

**Testicular atrophy:** The testicle consists mainly of a group of tubes responsible for producing sperm cells. When these tubes are damaged as a result of the effect of varicoceles, this may lead to shrinkage of the testicle. One possible explanation for this condition is that the accumulation of blood in the testicle increases the effect of toxic substances, leading to cell death.

**Infertility:** There is a definite link between varicocele and decreased fertility in males, but the mechanism by which varicocele affects sperm production from the testicles is still not entirely clear. Researchers have proposed several explanations, the most prominent of which is that varicocele causes an increase in testicular temperature, which negatively affects sperm production and sperm motility and function. It is important to note that varicocele in the left testicle may negatively affect sperm productionT in the right testicle.

**Symptoms of varicocele**

Varicocele is usually not accompanied by clear symptoms, or may cause mild and non-serious symptoms. The most prominent of these symptoms are:

**Pain:** The pain resulting from varicocele ranges from sharp and painful pain or a slight feeling of discomfort. The pain increases when standing for long periods, and appears especially at the end of the day after work, and decreases with rest and lying down.

**Scrotal swelling:** At first, varicocele is small and unnoticeable, and cannot be seen. But when it grows large enough, it appears as a soft mass of swollen, twisted veins, located above the testicles in the scrotum.

**Difference in the size of the testicles:** Varicocele that is left untreated for a long time may lead to delayed growth of the testicle on the affected side, making it appear smaller in size compared to the testicle on the other side.

**Infertility:** Untreated varicocele can lead to infertility, but it is not an inevitable outcome in all cases

**Treatment of varicocele with interventional radiology without the need for surgery**

Varicocele is treated using interventional radiology. Here is a summary of these steps:

1. **Evaluation and diagnosis**: The specialist doctor evaluates the condition of the testicle and determines the size and extent of the varicocele. This includes performing a clinical examination of the testicle in addition to additional tests such as X-rays or computed tomography (CT scan) using the advanced CT scan device available at the center, or magnetic resonance imaging (MRI) to accurately determine the size and location of the varicocele.

2. **Preparation for treatment**: The patient must prepare for interventional radiology treatment, as he is placed in a lying position on his back.

3. **Local anesthesia**: Local anesthesia is used to ensure the patient's comfort during treatment and avoid feeling pain, as the targeted area is anesthetized through local injections to numb the skin and tissues surrounding the testicle.

4. **Interventional Radiology Guidance**: The fine catheter is guided towards the dilated veins in the testicle using ultrasound or X-ray imaging techniques to ensure accurate access to the desired location.

5- Vein Closure: The dilated veins are closed using spiral coils or adhesive materials, which contributes to improving blood flow to the testicle after the procedure is completed.

6- Rest and Recovery: The patient is advised to rest for a short period after interventional radiology treatment, after which he can return to his daily activities relatively quickly.

7- Follow-up and aftercare: After interventional radiology treatment, the patient's condition is monitored for a certain period to ensure that symptoms improve and the desired results are achieved. This follow-up may include additional tests such as semen analysis to assess the effect of treatment on male fertility.

**How ​​the procedure is performed**

 

There are three surgical options for treating varicocele, as follows:

**Traditional surgery** This procedure is performed under local or general anesthesia, where the doctor reaches the varicocele area, often through the thigh, and in some cases through the abdomen. Ultrasound and surgical microscopes are used during the procedure. During this procedure, the affected veins are closed to redirect blood flow through healthy vessels. The patient usually feels mild pain after the procedure, and can return to his normal life in a short period of time.

**Laparoscopic surgery**

In this type of varicocele surgery, the following steps are performed:

The doctor begins by making a small incision in the abdominal area, and through this incision, the endoscope is inserted, allowing him to see the affected area through the camera. The doctor then inserts surgical tools through the incision, where he cuts any enlarged veins that obstruct blood flow, and then closes the ends of the veins using small clips or by heat. After completing these steps, the tools and endoscope are removed, and the procedure is concluded.

The results of these procedures are similar, but the man may face some problems after the procedure, which include:

- Varicocele persists or returns again.

- Fluid accumulation around the testicles.

- Injury to the testicular artery.

Percutaneous embolization is a less common procedure to treat varicocele. The doctor does the following:

The doctor inserts a tube or catheter into the body through the neck or groin (percutaneous embolization).

The doctor uses X-rays to locate the varicocele, then inserts a balloon or coil through the tube to block blood flow to the enlarged veins. This is done under general anesthesia.

Possible problems that may follow this procedure include:

The varicocele persists or returns.

Fluid buildup around the testicles.

Injury to the testicular artery.

Percutaneous embolization.

Another less common procedure to treat varicocele that the doctor may do is the following:

The doctor inserts a tube or catheter into the body through the neck or groin (percutaneous embolization).

The doctor uses X-rays to locate the varicocele, then inserts a balloon or coil through the tube to block blood flow to the varicocele. This is done under general anesthesia.

Possible problems that may occur after this procedure include:

 

Varicolecules not being removed or possibly coming back.

Infection.

Movement of the balloon or coils that were inserted.

**Treatment of Varicocele Pain**

In many cases, varicocele treatment is not required, as treatment is provided to men who suffer from:

- Fertility problems (difficulty conceiving children).

- Feeling pain.

- The left testicle grows more slowly than the right testicle.

- Abnormal results in semen analysis.

Treatment of varicocele with medications:

Many studies and research have been conducted so far, but no effective treatment for varicocele or ways to prevent it have been found. However, if you are experiencing some pain, you can use a painkillerAcetaminophen or ibuprofen are used to relieve pain.

Surgery is the primary treatment option, but many doctors only resort to it in cases of embolization, as short-term blockage of the veins is a non-surgical treatment option.

**Surgical treatment of varicocele:**

There are several methods for performing varicocele surgery, all of which aim to block blood flow in the affected plexus veins. The surgery is performed under general anesthesia, and patients usually return to their daily activities after one week with mild pain. Among the most common surgical methods is microscopic varicocelectomy.

Varicolectomies take about 3 hours.

The doctor begins by making a 1-cm incision above the scrotum.

The doctor then ties off the small veins while preserving the spermatic cord and vas deferens arteries, in addition to maintaining lymphatic drainage.

The patient can leave the hospital the same day.

Microscopic surgery has the lowest rate of varicocele recurrence.

Varicocele removal can also be performed using a laparoscope.

The procedure takes 40 minutes.

The doctor performs the procedure in the abdominal area using thin tubes that are inserted to connect the veins.

The patient is discharged from the hospital the same day.

Surgery results:

Since surgeons have started using smaller incisions in the muscles to perform open surgery, recovery time and pain are almost the same as microsurgery and laparoscopic surgery. Complications after surgery are rare, but if they do occur, some potential problems include:

- Residual varicocele or recurrence (recurrence) in 1%.

- Fluid accumulation around the testicle (hydrocele).

- Injury to the testicular artery, which can lead to loss of the testicle.

Varicocele embolization:

The embolization procedure is performed by an interventional radiologist. Contrast injection through a tube is used under X-ray guidance to determine the source of the problem. The goal is to identify all the veins associated with the varicocele. Plug coils, either with or without a solid material, are used to prevent blood flow to the varicocele and cause scarring. The procedure is performed under either local anesthesia or light anesthesia, through a very small incision in the groin or neck area. This method usually takes between 45 minutes to an hour.

**After treatment**:

Healing after surgery is usually quick, and pain is usually mild.

You should avoid exercise for 10 to 14 days.

You can usually return to work 5 to 7 days after surgery.

You will also follow up with your urologist about the surgery for fertility problems, where a semen analysis will be performed after three to four months.

**Important tips after varicocele surgery**

 

After the procedure, there are a number of important tips that should be followed:

1. Follow your doctor's instructions regarding rest, taking medications or antibiotics at the specified times, and cleaning the operation area periodically.

2. Use cold compresses on the scrotum, as they help relieve pain and reduce swelling.

3. Avoid some activities such as sexual intercourse, exercise, and any strenuous physical effort, in addition to avoiding swimming and exposing the affected area to water.

4. Be careful to avoid constipation to avoid straining during defecation, and laxatives can be used with a prescription to facilitate the defecation process.

**Possible side effects of the operation**

 

You should consult a doctor if you notice any of the following symptoms:

- Difficulty urinating or inability to empty the bladder completely.

- Redness or inflammation in the scrotum area.

- Unusual swelling that does not improve with the use of cold compresses.

- Feeling nauseous or vomiting.

- Pain or swelling in the leg.

- High body temperature.

**Complications of varicocele surgery**

 

Several complications can occur after surgery to treat varicocele. If any of these complications occur, you should seek immediate medical attention, as these complications can be serious and life-threatening. Here are some of the complications that may occur as a result of surgery:

- **Deep vein thrombosis**: Deep vein thrombosis occurs in 5% of patients, and this clot may travel to the lungs, leading to pulmonary artery obstruction, which occurs in less than 1% of cases.

- **Infections**: Infections may occur at the surgical site in less than 1% of patients.

- **Testicular shrinkage**: Testicular shrinkage is observed in less than 1% of patients, usually in the testicle closest to the surgical site.

- **Fluid accumulation around the testicle**: Fluid accumulation around the testicle, also called hydrocele, is known to occur in less than 1% of patients.

Recurrence of varicocele: It is noted that less than 5% of patients may suffer from recurrence of varicocele after surgery.

Failure to relieve pain: About 15% of patients may not be able to relieve pain, which leads to discomfort after surgery.

Sudden onset of pain: In rare cases, some people may feel sudden pain in the surgical area, even if there was no previous pain after the operation.

Persistent infertility: Infertility is usually treated after surgery, but there are some individuals who may continue to have infertility.

**Home remedies for varicocele**

 

Non-steroidal anti-inflammatory medications such as ibuprofen can be used, as these medications help relieve pain and do not require a prescription.

Applying an ice pack to the scrotum for 20 minutes can help relieve pain, especially during the first few days after surgery.

Elevating the scrotum on a pillow while sitting, in addition to lying down, helps relieve pain and reduce swelling.

Wearing a belt to support the scrotum in the first weeks after surgeryIt can relieve pain while standing, walking, or exercising.

If you have severe pain, you can take prescription pain relievers, but it is important to consult a doctor before using them.