Varicocele is a health condition were the veins in the Scrotum (the skin bag that contains a man’s testicles) become enlarged causing pain, discomfort and testosterone levels to drop. Varicocele is also referred to as Varicose Veins in the Scrotum similar to Varicose Veins in the legs. Varicocele can cause alarming symptoms such as severe pain in the scrotum, testicular pain, male infertility, impaired fertility, scrotal discomfort, scrotal pain and decreased testosterone production.
This health condition can affect a person’s life in multiple ways that are both physically and mentally draining. The exact reason for Varicocele cannot be particularly pointed out however, it usually forms during puberty and develops with time.
Varicocele Repair involves surgical procedures and non-surgical techniques that provide relief from this condition. This article dives deep into the symptoms of Varicocele, introduces an advanced minimally invasive technique which proves to be a smart option when compared with an open surgery and also provides a cost estimate for the same.
What is Varicocele?
When veins in the Scrotum become enlarged it causes blood to pool and affects overall blood flow which leads to testicular pain, decreased testosterone production and negatively influences the reproductive system in men.
The exact cause of Varicocele in not quite certain, but usually occurs when the valves in the spermatic cord prevents blood from flowing properly causing blood to pool and blood vessels to enlarge. Varicocele can also affect the sperm count and quality of sperm produced.
Varicocele Management depends on the severity of the condition and can be diagnosed during a physical exam or a scrotal ultrasound from a healthcare provider. Traditional Varicocele Treatment involves performing an open surgery called Varicocelectomy Surgery were the surgeon closes the affected veins in the scrotum to reroute blood via healthier veins.
This Varicocele Surgery involves a lot of risks since it is performed in a highly sensitive area such as the Scrotum. Several factors can contribute to complications including bruising, swelling or even injury to the testicular artery.
Symptoms Of Varicocele
Varicoceles affect approximately 15% of the male population. If left untreated for a long period of time it can lead to testicular atrophy, which means shrinkage in your testicle size. A Varicocele is quite challenging to identify and can be prevalent in a completely asymptomatic man too.
Sometimes only when this condition affects a patient’s fertility goals is when they take notice of this health issue and consider visiting a healthcare provider. However, common symptoms that a patient observes include,
Decreased Sperm Quality
When blood vessels swell up, they cause blood to start accumulating in a particular area thereby obstructing healthy circulation of blood. Blood pooling in the scrotum also leads to increased temperature and affects semen quality. A semen analysis from a healthcare provider can give you a detailed report regarding semen quality and sperm count.
Decreased Blood Flow
As the blood starts to collect in a particular area it remains stagnant and obstructs healthy veins carrying good blood too. Ultimately, this decreases blood flow in the Scrotum causing pain and swelling in the testicles. This condition is also known as testicle torsion.
Pain in the Scrotum
Pain in the Scrotum is the most common symptom of Varicocele and can also lead to pain in the lower abdomen. The intensity of the pain can vary depending on the severity of the condition and might worsen while indulging in physical activities.
The difference in pain can be noticed while lying down and usually reduces when compared with indulging in exercise or any other form of physical activity. If the severity of Varicocele is extreme the pain in the scrotum can also cause lower abdomen bloating or pain too.
Visible Enlarged Veins
Another symptom that can be easily diagnosed during a physical examination by a healthcare provider is, visible enlarged veins in the scrotum. This can even cause swelling in that region and is often compared with a bag of worms as it resembles the same. As an immediate relief pain medication is usually prescribed by a healthcare provider to reduce swelling and pain.
Infertility
Varicocele is basically abnormally dilated veins and can increase the temperature in the scrotum, as blood remains stagnant without flowing the temperature of that region begins to increase and obstructs free flow of healthy blood. When healthy blood containing nutrients don’t reach the testicles, it is deprived of essential blood supply and thereby the quality of sperm and count reduces causing infertility in men.
Surgical Procedures to Treat Varicocele
A Varicocele Surgery involves different types of procedures. The most common traditional surgical method is varicocelectomy surgery. Another surgical procedure that is known for its precision to treat a Varicocele is Microscopic Varicocelectomy.
Laparoscopic Varicocelectomy is a minimally invasive surgical procedure were the surgeon uses surgical tools attached to a video camera to identify and treat Varicocele. Below, are the procedures explained in detail
Types of Surgical Procedures
Varicocelectomy Surgery
Varicocelectomy is performed to treat Varicocele and is an open surgery which involves making large incisions. General anesthesia is first given to the patient as the surgery involves moderate amount of pain. The healthcare provider will make cuts on your skin to have a clear view of the affected region.
The healthcare provider will then access the varicocele through the inguinal canal located near the lower part of the abdomen. Usually, this surgery is performed by surgeons with medical expertise in Urology and Reproductive System.
The procedure involves physically cutting the veins and sealing the ends off to redirect blood through healthier veins. General anesthesia is considered vital in such open surgeries since they are performed in highly sensitive parts of the body. Once the surgery is done, silicon tubes are placed to drain blood in affected region and the cuts are stitched together.
Microscopic Varicocelectomy
In a Microscopic Varicocelectomy small incisions are made in the abdomen, groin area of the patient to send through a surgical microscope attached with small surgical instruments to locate and operate the affected veins causing Varicocele. The type of procedure performed can also depend on the grade of Varicocele, below are the different grades of Varicocele
Different Grades of Varicocele
- Subclinical Varicocele: This considered Grade 0 of Varicocele and usually cannot be detected during a physical exam by a healthcare provider however, it can be diagnosed using an ultrasound.
- Grade 1: Grade 1 is when it can be detected during a physical examination, it is small yet noticeable especially when your healthcare provider instructs you to use forceful breathing techniques to make it easier to detect Varicocele.
- Grade 2: When the size of the Varicocele is quite big, and your healthcare provider can physically feel it during examination.
- Grade 3: The largest size of Varicocele is during Grade 3 and the healthcare provider can clearly see it. This is when the symptoms are quite severe too.
Laparoscopic Surgical Treatment
Laparoscopic varicocele ligation
In a Laparoscopic Varicocele Ligation, a small camera along with surgical tools is sent through using small incisions in the abdomen area. In this procedure the affected veins causing Varicocele are clipped or tied into a knot. This cuts of the unhealthy blood flow and enables healthy blood to take a new vein route to reach the testicles. This helps improve fertility and alleviates other symptoms caused by Varicocele.
Laparoscopic Varicocelectomy
Laparoscopic Varicocelectomy is where a camera along with surgical instruments are sent through small incisions made near the abdomen or groin area of the patient. Unlike Laparoscopic Varicocele Ligation, this procedure is similar to Varicocelectomy. The only difference being large open cuts are not made on the skin, but through small incisions surgical tools are inserted to still cut off the affected veins.
Costs Associated with Varicocele Surgery
The approximate cost estimate for Varicocele surgery depends on various factors including healthcare provider, city etc. The admission discharge process may also vary with each healthcare provider and depending on the patient’s ability to recover from the surgery. On an average, in India approximately the price starts at Rs. 40,000 and can go up to a lakh, depending on these factors.
Disadvantages of Surgical Procedures for Varicocele
Varicocele is enlargement of veins in the Scrotum. The scrotum is a sensitive organ that holds the testicles of a man. Varicocele surgery aims to relieve the symptoms caused by enlargement of these veins by physically cutting affected veins through an open surgery, the veins are tied off / clipped to redirect flow of blood to healthier veins, tiny surgical instruments along with a camera are used to enter the body through small incisions to treat the affected veins.
These surgeries prove to be beneficial by alleviating symptoms of Varicocele and in fact have helped improve fertility in men. However, that’s just one side to the coin. Performing open surgeries on a highly sensitive organ such as the Scrotum can be quite risky. It includes various risks such as swelling, bruising to surrounding organs, injury to your testicular artery, infection, nerve damage, bleeding or even Hematoma (which is collection of blood around the testicles).
Interventional Radiology: A Non-Surgical Alternative to Treat Varicocele
Introducing Varicocele Artery Embolization
Varicocele Embolization is an Interventional Radiology technique that involves redirecting blood away from an enlarged vein in the Scrotum. A radiologist uses a coil or special agents to embolize the vein. This improves the overall symptoms caused by Varicocele and is a non-surgical procedure. Since the procedure is minimally invasive in nature, it provides a faster recovery phase to patients. Other benefits of Varicocele Embolization include,
Advantages of Varicocele Artery Embolization
Minimally Invasive
This procedure is not considered a surgery, in fact it is best known as a minimally invasive technique. Varicocele Embolization only uses minor incisions in the lower abdomen or the groin region to enter the site of the affected vein. So, since there are no large incisions, need for stitches or sutures are completely eliminated thereby providing smooth recovery to patients.
Outpatient Procedure
Unlike a Varicocele Surgery, Varicocele Embolization does not require the patient to get admitted for days. It is an Outpatient procedure which means the patients is allowed to get discharged the very same day. To determine whether this procedure can be covered under health insurance depends on the type of insurance and healthcare provider.
Lower Risk of Complications
Varicocele Embolization reduces testicular pain associated with Varicocele and alleviates other symptoms along with minimalizing the risk of complications associated with treating this condition using traditional surgical methods. Since this procedure is completely non-surgical it does not cause any complications and reduces severe risks associated with surgical procedures such as blood loss and infection.
Faster Recovery
Patients don’t need to get admitted to Hospitals for days altogether. Varicocele Artery Embolization is a daycare procedure which means they get discharged the very same day. Along with this perk, there are no sutures, scars, stitches involved during this technique enabling the patient to recover as quick as possible.
Conclusion
Varicocele is basically enlargement of the veins in the Scrotum, a bag that holds a man’s testicles. When the veins become enlarged, the blood flow gets obstructed, reducing the flow of healthy blood to the testicles. This may cause severe complications which may even include infertility in men. Varicocele Surgery are of different types such as Varicocelectomy, Laparoscopic Varicocelectomy and Laparoscopic Varicocele Ligation.
Open surgeries to treat Varicocele prove to provide relief from its symptoms but also involve their own set of risks and complications. These complications might be quite severe and may also include blood loss, infection and damage to surrounding organs. Interventional Radiology technique such as Varicocele Embolization is a non-surgical procedure which does not involve making large incisions thereby minimalizing risks and complications involved. It is also a daycare procedure which means the patient can get discharged the very same day too.
If you are suffering with Varicocele or feel that you might have its symptoms, consider visiting your healthcare provider. Your healthcare provider will diagnose the severity of the condition and recommend appropriate treatment options.
Encourage readers to schedule a consultation or learn more about available treatments at your facility.
