Varicocele is a condition involving the veins of the testicles. This condition is relatively common and usually harmless. However, in some cases it can be associated with various complications including infertility.
The blood is drained from the testicles by testicular veins that run from scrotum through inguinal canal into the abdominal cavity. The veins are equipped with valves that allow one-way flow of blood. If these valves are damaged, or if the veins are compressed from the outside, the blood flow out of the testicle is disrupted. The veins can accumulate with blood causing local expansion of the veins (local varices). The venous blood may accumulate even in the affected testicle, which may enlarge. In addition, any local tumors or metastases in the lower abdominal area can compress the testicular veins and cause similar problems.
Mild forms of varicocele are present in a lot of men. The mild forms are asymptomatic, but sometimes they may cause slight enlargement of a testicle, which is accompanied with uncomfortable pressure sensation, which may turn into a testicular pain. In addition, the venous system of the testicle may be visibly dilated and twisted. Chronically lasting varicocele may damage the testicular tissue, the testicle shrinks (atrophy) and its function can be disrupted. More severe forms of varicocele may cause infertility.
The patients with above-stated difficulties should be investigated by a urologist. In addition to history and physical examination focused on the scrotum and testicles, ultrasound of the scrotal sac should be done to exclude other possible causes of testicular enlargement.
The question of whether to treat is not always easy. More extensive and symptomatic cases of varicocele should be solved. The classic therapeutic approach is surgical and it includes the removal of affected enlarged veins. Other possibility is local therapeutic embolization, which includes insertion of a special device into the veins that are closed from inside. The blood from the testicle is then drained by small lateral veins that are not dilated.