Varicocele: Varicose vein in testicle

Testis anatomy
FB Dr Soarawee
Soarawee Weerasopone, MD

Royal Phnom Penh hospital, Kingdom of Cambodia

Varicocele is another issue that bringing the patients to see me in the office. It is defined as an abnormal dilatation of scrotal venous plexus which bring low-oxygenation blood from the testicle. It looks similar to a varicose you might see in your leg and more often this condition happens with people getting old.

Varicocele: Varicose vein in testicle
Normal Anatomy of testicular venous plexus (Purple colour)
Varicocele (Enlarged testicular venous plexus)

Varicocele has been categorized as a silent disease, and we more often see this in the infertility clinic. It has been reported from 15% – 20% in adults males and skipping up to 40% in patients who are looking forward to find the infertility causes. The root cause has been jotting down as following.

Varicocele usually incidentally finds at infertility clinic
  1. From its anatomy, left side varicocele it looks larger and become noticeable than right side.
  2. Failure of anti-reflux valve within its own venous vessels.

The symptoms of Varicocele

  1. A couple complaining about the infertility issue
    • The infertility issue happens because of pooling of low-oxygenated blood and it decrease the sperm quality and quantity by oxidative stress, direct hydrostatic pressure and rising temperature on the testis.
  2. Testicular discomfort or feeling heaviness at the scrotal sac
    • With the same mechanism that causing infertility, the pain receptor at the testicles will express discomfort feeling when they are lying in optimum condition as they should be.
  3. Incidentally self-palpated “bag of worms” appearance at the scrotum during taking a shower
    • Varicocele divided into 3 stages, there’s a palpable on increasing the abdominal pressure, palpable or seeing by the bare eyes. The more severity type, the more patients can detect or feel by their own and leading them to seek for medical advice.

When patient come to have treatment with me for this suspected condition. A full completed history along with physical examination on the scrotum and high-resolution color doppler ultrasound must be done for the confirmation the diagnosis. If there is no effective medical treatment, surgical varicocele correction must be advised for the following indications.

  • Abnormal semen analysis
  • Pain related from the varicocele
Semen analysis
Abnormal semen analysis is a key indication for varicocele correction surgery

The most important method is “patient decision” since the correction surgery may not 100% guarantee to solve the concerned-problem and it also reported on the recurrence even after successful operation. If you have any questions, please discuss with your trusted urologist or it would be my pleasure if you text me for inquiries.

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