Tampa Urologist Treating Varicocele
Male reproductive system
The scrotum is a sac that contains the testicles, the male organs that produce sperm. The back of each testicle has a coiled tube, the epididymis, where the sperm are stored as they mature. The epididymis is connected to the prostate gland by the vas deferens, a part of the tissue bundle called the spermatic cord which contains many blood vessels. All veins contain valves, and sometimes these valves malfunction, allowing the blood to pool. This is called a varicose vein. A varicocele is a varicose vein of the testicle.
Varicoceles are very common, affecting 10 to 15 percent of all men. Although varicoceles are generally not painful and are not life-threatening, they are a common cause of male infertility. Most varicoceles produce no symptoms other than fertility problems, although a “heavy” or “dragging” feeling in the testicles is sometimes reported. If there is no discomfort and fertility is not an issue, treatment is not necessary as the condition is not serious.
About 40% of infertile males and up to 80% of men with secondary infertility (men who have fathered children in the past but are no longer able to do so) have varicoceles. Most varicoceles occur above the left testicle. The pooled blood in the vein raises the temperature of the testes. This affects sperm production, lowering sperm count and impairing sperm motility. The sperm may become malformed as well. It may be a progressive condition in which the sperm count and quality diminish over time.
Varicocele Exam and Diagnosis
Varicoceles vary in size and are easily diagnosed. Large varicoceles can be seen with the naked eye. Moderate varicoceles can be identified by palpation during a physical examination. To the practiced hand, the scrotum will feel like a “bag of worms”. Your doctor may ask you to perform the Valsalva maneuver. This is done while standing, and you will be asked to take a deep breath and bear down. This increases intraabdominal pressure, impeding drainage of the vein and increasing the size of the varicocele so that it may be more easily felt. An ultrasound may also be used if necessary.
Varicocelectomy is a minor surgical procedure where the blood flow is tied off of particular veins. Proper blood flow is reestablished, and improved fertility usually results. Two types are done: conventional where two to three inch incision is made in the groin, and microsurgical, where a smaller incision is made.
In the microsurgery, the surgeon only cuts the skin and fatty tissue and not the muscle, causing less pain and a faster recovery. The doctor identifies the varicoceles through an operating microscope. Large varicoceles are cut and stapled closed. Smaller varicoceles are cut and stitched shut. The operation takes less than an hour and recovery time is short. Semen quality is improved in most men. About half the men that have their varicoceles fixed will impregnate their wives by natural means within one year of the repair.