Varicocele is a mass of enlarged veins in the scrotum that develops in the spermatic cord, which leads from the testicles (testes) up through a passageway in the lower abdominal wall (inguinal canal) to the circulatory system. The spermatic cord is made up of blood vessels, lymphatic vessels , nerves, and the duct that carries sperm from the body (vas deferens). If the valves that regulate bloodflow from these veins become defective, blood does not circulate out of the testicles efficiently, which causes swelling in the veins above and behind the testicles.

Causes, incidence, and risk factors

A varicocele occurs when the valves within the veins along the spermatic cord don't work properly. The abnormal valves prevent normal blood flow and cause blood to backup, which dilates and enlarges the veins. This is essentially the same process as varicose veins, which are common in the legs.

Varicoceles usually develop slowly and may not have any symptoms. They are most common in men between 15 and 25 years old, and 75-80% of those with varicoceles have swelling in only the left side of the scrotum. Varicoceles are often the cause of infertility in men.

The sudden appearance of a varicocele in an older man may be caused by a kidney tumor that has affected the renal vein and altered the blood flow through the spermatic vein .

Symptoms

• Visible, enlarged, twisted veins in the scrotum
• Infertility
• A painless testicle lump, scrotal swelling, or bulge within the scrotum, more common on the left side
  • Lump will disappear when sufferer is in horizontal (laying down) position due to lack of gravitational pull on the blood

Signs and tests

Upon palpation of the scrotum, a non-tender, twisted mass along the spermatic cord is felt (it feels like a bag of worms.) However, the mass may not be able to be felt or obvious, especially when lying down. The testicle on the side of the varicocele may or may not be smaller compared to the other side.

Treatment

Varicoceles may be managed with a scrotal support (e.g. Jockstrap, Briefs). However, if pain continues or if infertility or testicular atrophy results, the varicocele may need to be surgically ligated (tied off).

Varicocelectomy , the surgical correction of a varicocele, is performed on an outpatient basis. The cut is usually made in the lower abdomen, although various techniques can be used. Ice packs should be kept to the area for the first 24 hours after surgery to reduce swelling. The patient may be advised to wear a scrotal support for some time after surgery.

Possible complications of this procedure include hematoma (blood clot formation), infection, or injury to the scrotal tissue or structures. In addition, injury to the artery that supplies the testicle may occur.

Prognosis

A varicocele is usually harmless and often requires no treatment. If surgery is required because of infertility or testicular atrophy, the outlook is usually excellent.

Source

• Varicocele. MedlinePlus Medical Encyclopedia. US Federal Government public domain. Update Date: 11/12/2003. Updated by: Scott M. Gilbert, M.D., Department of Urology, Columbia-Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.