Varicoceles is the enlargement of veins in the scrotum (the pouch of skin that holds your testicles). It is similar to a varicose vein you might see in your leg.
Varicoceles are common cause of low sperm production and decreased sperm quality, which could lead to infertility. Varicoceles could also cause testicles to shrink.
Varicoceles rarely hurt. It often produces no signs or symptoms. However, you might experience or observe :
- Smaller testicle on the varicocele side.
- A lump in one of your testicles.
- Swelling in your scrotum.
- Visibly enlarged or twisted veins in your scrotum, often described as looking like a bag of worms.
If yours does cause pain, it might vary from dull to sharp recurring pain in your scrotum
A scrotal ultrasound will be performed. Ultrasound measures the veins and allows your doctor to get a detailed and accurate picture of the condition.
There are a few approaches :
- Open varicocele ligation – This procedure involves ligating or tying off all abnormal veins that drain the testicle to help restore normal blood flow. All venous channels which drain the testis can be visualized and treated.
- Laparoscopic varicocele ligation - a camera and small instruments are introduced to the abdomen, where the veins feeding the varicocele are clipped.
- Microsurgical subinguinal varicocele ligation - An incision is made in the lower groin area, and the spermatic cord is isolated. All of the veins feeding the varicocele are identified and divided, while important structures for testicular function especially the artery are preserved.
- Varicocele embolism – An incision is made in the skin, usually in the groin. A small catheter is threaded through the incision and into a vein in the groin. Metal coils are inserted into the catheter and then into the varicose veins of the varicocele. This essentially blocks off the affected veins and causes a redirection of blood flow back to the circulatory system via an alternate pathway through healthy veins.
- A high powered surgical microscope is used to perform the operation.
- The image viewed through microscope shows the key structures at >20X magnification.
- It helps in the precise identification of veins, and preserving all-important structures especially the artery, so as to maximize efficacy and minimize complications.