Varicocele Varicose veins in the scrotum

Varicocele is an enlargment of the pampiniform plexus veins of the spermatic cord. It is present in 15% of men, and in 40% of men with subfertility. In 80 to 90% of cases, it occurs in the left testicle, due to the insertion of the spermatic vein into the homolateral renal vein.

It occurs due to valve incompetence in the venous drainage of the spermatic cord and can interfere with spermatogenesis and the endocrine function of the testicles (testosterone production), and its timely treatment influences both parameters.

The possible causes for the appearance of varicocele are generally unknown, idiopathic. Sometimes it can be a manifestation of retroperitoneal disease in cases of sudden and / or bilateral appearance.

Classification:

Grade I - palpable only with increased abdominal pressure (valsalva maneuver)

Grade II - palpable without valsalva maneuver, standing

Grade III - visible through the scrotal skin at rest

Subclinical - asymptomatic varicocele detected on ultrasound (veins diameter> 3mm with flow inversion with valsalva maneuver)

The most common signs and symptoms are the presence of scrotal discomfort or pain, particularly after physical activity or exertion. Sometimes an enlargement of the scrotum or dilated vessels surrounding the testicle may be visible and even palpable. In younger individuals, an asymmetry of the testicular volume can be seen with atrophy of the affected testicle.

In cases associated with sub-fertility / infertility, the personal reproductive history should also be assessed.

In these cases, the most common alteration associated with varicocele is the presence in the spermogram of an anomaly called “stress pattern” - OligoAstenoTeratozoospermia - with changes in the shape, quantity and motility of the sperm.

The success of surgical repair is associated with an improvement in spermogram parameters in 50-80% of cases.

The complementary diagnostic examination indicated is the Scrotal Doppler Ultrasound, with evaluation of the caliber of the spermatic cord vessels and evaluation of the presence or absence of flow inversion using the valsalva maneuver.

Patients with asymptomatic varicocele, not palpable with valsalva maneuver and only detected on scrotal ultrasound, do not have indication for surgical treatment.

Indications for surgical treatment are:

- adolescents or young adults with varicocele and homolateral testicular atrophy

- situations of discomfort and persistent pain

- evident aesthetic motives

- in the context of sub-fertility / infertility

Varicocele treatment can be performed by classic open surgery, microsurgery, laparoscopic surgery or percutaneous embolization.

The approach may be sub-inguinal, inguinal or retroperitoneonal, according to the specificities of each technique.

The risk of recurrence varies between 2% to 20%.